Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships

Abstract

Feedback in medical education has traditionally showcased techniques and skills of giving feedback, and models used in staff development have focused on feedback providers (teachers) not receivers (learners). More recent definitions have questioned this approach, arguing that the impact of feedback lies in learner acceptance and assimilation of feedback with improvement in practice and professional growth. Over the last decade, research findings have emphasized that feedback conversations are complex interpersonal interactions influenced by a multitude of sociocultural factors. However, feedback culture is a concept that is challenging to define, thus strategies to enhance culture are difficult to pin down. In this twelve tips paper, we have attempted to define elements that constitute a feedback culture from four different perspectives and describe distinct strategies that can be used to foster a learning culture with a growth mind-set.

Identifying coaching skills to improve feedback use in postgraduate medical education

“…The need to ensure safe practice differs in a significant way from the sports, music and business environments where achievements are individually oriented with little or no impact on the safety or well‐being of others. Such tension has been found in other studies and speaks to the importance of guiding residents as well as also supporting their progressive independence. Cultivating a resident's understanding of the crucial role of accurate self‐assessment as part of a self‐regulating profession is an important outcome .…”

“…Achieving a balance in the discussion with residents between coaching and pre‐emptively identifying the goals and actions independent of the resident is challenging for supervisors and has been noted in other coaching contexts . Although facilitative versus directive feedback techniques have been found to be more helpful, it can be tempting for supervisors to distrust residents’ ability to identify appropriate goals, often based on the limitations posed by inaccurate self‐assessment . This limitation becomes less problematic when external data is provided, discussed and understood prior to discussing goals and next steps.…”

“…coach is familiar with context and content of the assessment 13,47,49,50 Feedback: coach provides feedback about performance and engages learner in discussion 14,51,52,53 Preparation of the resident:…”

“…Longitudinal relationships built on trust that facilitate a dialogue based on accurate, in-depth knowledge of the learner are frequently lacking in medical education settings, preventing the more directive and constructive feedback seen in other coaching settings. [9][10][11][12] Other barriers in medical education, when compared with sport or music settings, that impair productive coaching conversations, including the lack of a continuous improvement stance focused on working towards full potential; 4,9,13,14 the perceived need to maintain a comfortable relationship; 12 and the use of vague language to save face. 15 Other research identifies internal factors within the medical learner that negatively influence their willingness to engage in feedback and performance conversations, such as skepticism about the process, their wish to appear competent and the possible conflict with their own self-assessment.…”

The three Fs: three steps to promote learner growth

“…To achieve this goal, I provide and encourage, in the words of a former student, ‘clear, actionable, and useful feedback’. By emphasising that we can all improve, we help each other to realise our goals through providing, welcoming and seeking feedback while maintaining a growth mindset …”