Desired features of feedback in a high-paced clinical setting: A Q-methodology study

Abstract

Introduction: The transformative learning potential of feedback, a key pillar of competency-based medical education, can only be fully realised when a learner's preferences are integrated into the feedback process. However, there is limited understanding of medical residents' preferences, which could better inform this process. This study investigates patterns in emergency residents' perspectives on preferences for feedback features and their potential implications on learning. Methods: We used Q-methodology, which combines quantitative and qualitative data to systematically rank and compare shared and distinct perspectives on a specific topic. Thirty-two purposively sampled emergency medicine residents from 11 teaching hospitals were each invited to participate in a Q-sorting exercise and post-sorting interview. We analysed the Q-sorts to identify patterns in residents' preferences for feedback features. Qualitative insights from the interviews facilitated a structured interpretation and understanding of the differences and similarities between the generated viewpoints. Viewpoints represent subjective yet shared patterns of similarity in opinions about the most and least desirable feedback features, based on how residents ranked statements reflecting these features. Results: Of the 32 Q-sorts, 27 (84.4%) successfully loaded onto four different viewpoints reflecting prevailing perspectives of feedback preferences during residency training: (i) specific and comprehensive feedback; (ii) safe and evidence-based feedback; (iii) timely and relationally grounded feedback; and (iv) growth-focused and motivational feedback. Despite differences, residents across all viewpoints stressed the importance of obtaining feedback during crucial moments in their learning process. Discussion: Residents' preferences for feedback vary, suggesting that a universal approach to providing feedback may not be effective. Instead, various characteristics must be considered, reinforcing the necessity for innovative feedback practices to meet individual learners' unique needs in the clinical workplace.