Cultural influences on Asian health profession trainees seeking and receiving feedback: a scoping review

Feedback is recognised as key to learning and development of health professionals. However, most literature regarding this originates in Western contexts, leaving a significant gap in understanding how Cultural factors influence feedback practices elsewhere. This scoping review focuses on the Cultural values that shape how feedback is sought, provided, and received in Asia and how Culture influences health professions trainees' engagement with feedback during clinical training. The influence of Culture on supervisors' feedback practices is also explored.

Four databases - CINAHL, ERIC, MEDLINE and PsycINFO - were searched and results imported into Covidence for screening. Included articles were transferred into NVivo for coding. A coding framework was developed and iteratively refined through team discussions to ensure analytic rigour.  RESULTS: The search, conducted up to June 2024, yielded 1241 citations, with an additional 51 identified through citation searching. Thirty-seven studies met the inclusion criteria and were analysed. The review identified three interconnected themes. In Asian settings, feedback is impacted by: 1. Components of Culture, 2. Preferences for receiving feedback, and 3. Perceptions of feedback emphasised error identification. 1) Components of Culture: Culture (particularly power distance and collectivism) strongly influenced how feedback was perceived and enacted. 2) Preferences for receiving feedback: Trainees had diverse perspectives about the role and use of feedback. Group feedback was used substantially more than in Western settings. 3) Perceptions of feedback emphasised error identification: Feedback is shaped by hierarchical relationships and emphasised errors.

Feedback was important and desired by trainees while Culture influenced the way feedback was given and received. High power distance and collectivism had the most obvious effects, inhibiting trainees from seeking or requesting clarification of feedback. Supervisor authority was maintained by power distance. Collectivism, power distance and the impact of clinical service pressures resulted in much feedback being given to trainees in groups. Supervisors saw feedback as telling, more commonly unidirectional than dialogue, and emphasising errors. Trainees accepted this if advice for improvement was included. Error correction required harshness to reinforce the feedback message - supervisors and trainees regarded positive feedback as "praise", having little overall value in learning or competence.