Image courtesy: Ana Hategan

Image courtesy: Ana Hategan

Feedback is an essential and core component of medical training and growth in residency, especially when implemented and executed effectively. As learners, we crave feedback. When done appropriately, it can be a source of immediate, inexpensive, focused learning that is readily available. Despite its historical influence on medical teaching, programs continue to struggle to implement a culture and process of transmitting effective feedback, separate from evaluation. Wood (2000) identifies two situations that result in deficient feedback: the infrequency with which trainees are closely observed performing a skill or participate in deep discussion with a mentor, and the unease felt by preceptors in delivering feedback.

How is feedback defined in the literature?

van de Ridder et al (2008) reviewed the literature defining feedback in medical education with the goal of proposing an operational definition of feedback in clinical education. They define feedback as “specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance” (van de Ridder, 2008). In other words, feedback is intended to narrow the gap between actual and desired performance resulting in improvement (Ramaprasad, 1983).


What is the relationship between feedback and assessment? See answer below.

  • Formative assessment (e.g., feedback) is about providing feedback to students in order to support and enhance learning.
  • Summative assessment (e.g., overall judgement) is about measuring students’ achievement with the purpose of grading or informing decision about progression.

Why is feedback important?

Feedback is essential for personal and professional development. In fact, trainees crave feedback and it contributes to a sense of improvement and mastery. The adage “see one, do one, teach one” depends on appropriate feedback to achieve the desired outcome. From clinical interviews to procedures, feedback helps improve and reinforce performance, efficiency, and competence (Hargreaves et al, 1997).

What are some challenges with delivering effective feedback?

As illustrated in Table 1, not all feedback is created equal. Some barriers to the delivery of effective feedback include:

  • It is difficult to do well.
  • It is double-edged in that it can reinforce and modify behaviour or result in demotivation (a component of burnout) and deterioration in performance if not managed carefully.
  • Most teachers get little or no instruction in giving feedback.
  • Teachers feel negative feedback can be pointless if there are no resources to help students improve.
  • Fear of damaging their relationship with learners and wanting to avoid undermining learner’s self-esteem.
  • Corrective feedback can feel awkward to communicate.
  • Teachers do not want to appear critical.
  • Learners can become defensive when offered corrective feedback.

Table 1. Barriers to delivering effective feedback
Difficulty to do well
Double-edged nature: can reinforce good behaviours as well as demotivate
Lack of training in how to give effective feedback
Lack of resources for helping learners follow up on topics discussed during feedback session
Fear of damaging interpersonal relationship through providing corrective feedback
Awkwardness associated with giving corrective feedback
Not wanting to appear “too critical” or “harsh”
Encountering defensiveness among individuals receiving feedback

How can we improve the process of giving and receiving feedback?

As shown in Table 2, several strategies can help improve the process of providing feedback (Cantillon & Sargeant, 2008; Veloski et al, 2006). These strategies include the following:

Table 2. Suggestions for improving the feedback process
Strategy Process
Normalize it Make it an everyday component of the teacher-student relationship
Set expectations Clarify expectations and criteria against which performance will be assessed
Be specific Feedback should be on specific behaviours rather than general performance
Make it non-judgmental Focus on what was directly observed and use non-judgmental language
Be timely Offer feedback at the time of an event or shortly afterwards
Stay focused Limit topics to one or two items only
Seek balance Seek what the learners’ own perception of their performance was and their ideas for improvement
Encourage learners to routinely appraise and correct their own performance, which helps reinforce lifelong learning
Catalyze change Ask the learner how he/she might incorporate feedback into practice to narrow the gap between actual and desired performance

How can you, the learner, ask for feedback?

Try these methods of giving feedback

Table 3. Reflective feedback conversation method
Process Example
The teacher asks the learner to share any concerns he/she may have about the recently completed performance “Let’s review the surgery. Is there anything you have concerns about, that perhaps didn’t go as well as you had hoped?”
The learner describes concerns and what he/she would have liked to have done better “I wasn’t happy with tumour resection; I found it very hard to prize it off the posterior wall of the bladder and it bled a lot.”
The teacher provides views on the performance of concern and offers support “It was clearly difficult for you to create a plane of cleavage between the tumour and the bladder wall. I find this difficult too.”
The teacher asks the learner to reflect on what might improve the situation “Is there anything you can think of that might work better, make it easier, or improve it for next time?”
The student responds: “Well I was a bit anxious and perhaps because of that I was rushing and working too quickly.”
The teacher elaborates on the trainee’s response, correcting if necessary, and checks for the trainee’s understanding “Yes, that’s a good point. I would encourage you to slow down at times like these and that allows you to be even more delicate in your approach. Another suggestion is to use a blunt dissection technique rather than a scissors dissection. Does that make sense to you?”

Did you know?

Studies show, your perception of feedback and the evaluation process profoundly influences the contribution it makes on your learning (Watling & Lingard, 2012).