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Building an implementation framework for directly observed feedback by attending physicians
Andrew Vincent Raikhel1, Helene Starks2, Gabrielle Berger1
1Division of General Internal Medicine, University of Washington, Seattle, Washington, United States of America.
Plos One
|February 9, 2026
Summary
Directly observed feedback in medical education is acceptable to most residents and hospitalists. Key concerns include observer relationships and learning environment impact, emphasizing the need for psychological safety.
Area of Science:
- Medical Education
- Healthcare Professional Development
- Competency-Based Education
Background:
- Effective formative feedback is crucial for resident training in competency-based medical education.
- Current feedback curricula often lack observation of actual verbal feedback delivery.
- Directly observed feedback is a novel approach with limited research on attitudes.
Purpose of the Study:
- To explore attitudes towards directly observed feedback among Internal Medicine residents and hospitalists.
- To identify concerns and suggestions regarding the implementation of observed feedback.
Main Methods:
- Two surveys were developed for Internal Medicine residents and hospitalists at the University of Washington in 2023.
- Surveys utilized quantitative (Likert scale) and qualitative (free text) analyses.
- Study design incorporated principles of social cognitive theory.
Main Results:
- Response rates were 71% for residents and 57% for hospitalists.
- A majority reported comfort with observed feedback (81% residents, 64% hospitalists).
- Concerns centered on observer relationships, learning environment, and feedback quality; suggestions focused on boundaries, agency, and integrity.
Conclusions:
- Attitudes towards observed feedback are influenced by social monitoring and the need for psychological safety.
- Implementing observed feedback requires careful consideration of relational dynamics and learner well-being.
- Psychological safety is fundamental for successful observed feedback programs in medical training.
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