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Only When They Seek: Exploring Supervisor and Resident Perspectives and Positions on Upward Feedback
Subha Ramani1, Rachelle C W Lee-Krueger, Amanda Roze des Ordons
1Dr. Ramani: Associate Professor of Medicine, Harvard Medical School, Boston, MA, and Director, Program for Research, Innovations and Scholarship in Education, Department of Medicine, Brigham and Women's Hospital, Boston, MA. Dr. Lee-Krueger: PhD Candidate, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Roze des Ordons: Clinical Associate Professor, Department of Anesthesiology, Pharmacology and Therapeutics; and Divisions of Critical Care Medicine and Palliative Care, Department of Medicine; University of British Columbia, Canada. Dr. Trier: Assistant Professor, Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada. Dr. Armson: Professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Könings: Associate Professor, Department of Educational Development & Research and Graduate School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; and Dr. Lockyer : Professor Emerita, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Introduction:
Verbal feedback from trainees to supervisors is rare in medical education, although valuable for improvement in teaching skills. Research has mostly examined narrative comments on resident evaluations of their supervisors. This study aimed to explore supervisors' and residents' beliefs and experiences with upward feedback, along with recommendations to initiate and facilitate effective conversations.
Methods:
Using 60-minute focus group discussions, a previous study explored opinions of internal medicine residents and clinical supervisors at the Brigham and Women's Hospital regarding the impact of institutional culture on feedback conversations. For this study, we conducted a thematic analysis of the transcribed, anonymous data to identify key concepts pertaining only to verbal upward feedback, through the theoretical lens of Positioning theory.
Results:
Twenty-two supervisors and 29 residents participated in three and five focus groups, respectively. Identified themes were mapped to three research questions regarding (1) existing beliefs (lack of impact, risks to giving supervisors feedback, need for preparation and reflection), (2) experiences (nonspecific language, avoidance of upward feedback, bypassing the supervisor), and (3) recommended approaches (setting clear expectations, seeking specific feedback, emphasizing interest in growth).
Discussion:
Study participants appeared to assume learner-teacher positions during feedback conversations, resulting in residents' concerns of adverse consequences, beliefs that supervisors will neither accept feedback nor change their behaviors, and avoidance of constructive upward feedback. Residents suggested that emphasis on mutual professional growth and regular feedback seeking by supervisors could encourage them to take on the role of feedback providers. Their recommendations could be a valuable starting point for faculty development initiatives on upward feedback.
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