Resident Teachers and Feedback: Time to Raise the Bar

Abstract

FRCP(C) M edical student learning is powerfully influenced by the residents with whom students interact. Recognizing the importance of residents as teachers of their students, medical schools are increasingly asking—and being asked by accrediting bodies—how residents are prepared for their teaching role. Supporting residents to be effective teachers requires not only a sound notion of what attributes influential teachers possess, but also a plan for how those traits can be nurtured. Two papers in this issue address these issues. Melvin et al 1 address the first requirement by exploring medical students' perspectives on the qualities they most value in resident teachers. Tuck et al 2 address an aspect of the second requirement, exploring residents' perspectives on the feedback they receive from students—feedback intended to develop and enhance their teaching performance. The articles offer useful insights into how we can define and support effective teaching among residents. Both articles also highlight the larger, thorny problem of feedback in medical education. Feedback is widely endorsed as an essential facilitator of learning. Thirty years ago, Ende 3 warned that without feedback, ''mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically, or not at all.'' But the achievement of competence cannot possibly hinge on feedback unless the feedback offered is of good quality and the process by which it is received and acted upon is understood and supported. Despite a great deal of emphasis on the importance of feedback for learning, and monumental efforts to train faculty—and residents and students, for that matter—in how to deliver feedback, medicine remains plagued by vague and often meaningless feedback. Re-search on feedback conducted during the last few decades has helped us to understand why. Historically, much of the work on feedback has treated it as a commodity, focusing on how to construct and deliver it, with little attention given to what happens next. Issues of construction and delivery are not unimportant; few would dispute the idea that feedback should be specific, timely, based on observable behavior, credible, and actionable in order to be perceived as effective. How feedback is given, however, is only part of the picture. How feedback is received, reacted to emotionally, judged, and integrated by learners is equally critical. 4 Feedback that threatens self-esteem, or that is in conflict with self-perception is very difficult for learners to use, regardless of how carefully it is constructed and delivered. 5 Learning culture—the environments, opportunities, pedagogic approaches, and professional values that underpin the educational experience—is an added important influence, supporting or sometimes constraining the exchange of meaningful feedback.