Daily feedback in the emergency department: barriers and enablers

Feedback is a cornerstone of competency-based medical education and critical for learner development in emergency medicine. Despite its importance, feedback conversations are often inconsistent, incomplete, or avoided-particularly when addressing areas for improvement. Anecdotal evidence suggests that clinical teachers may withhold constructive feedback due to fear of retaliation or negative consequences, yet this phenomenon remains underexplored in the literature.

We conducted a cross-sectional, multi-site, descriptive survey-based study of EM clinical teachers and trainees across three academic hospitals affiliated with McGill University. Using DeVellis' framework, we developed a survey tool exploring participant perceptions of daily feedback conversations, with emphasis on barriers, facilitators, and the influence of fear of retaliation. Surveys were distributed from April to June 2023 and analyzed using descriptive statistics and qualitative content analysis.

Of 193 eligible participants, 87 (45%) completed the survey (39 clinical teachers, 48 residents). Both groups described daily feedback as a key learning tool, particularly for procedural skills, communication, and professionalism. Positive feedback was seen as motivating and growth-promoting. However, 25% of clinical teachers reported avoiding or softening difficult feedback due to concerns over resident defensiveness, being perceived as mistreating learners, or fear of negative evaluations. Structural barriers such as time constraints, lack of privacy, and the burdensome process of formal failure further limited constructive feedback delivery. Trainees, in contrast, rarely reported interpreting constructive feedback as punitive and instead expressed a desire for more honest, specific feedback. Time pressure, limited privacy, and unclear expectations were additional barriers described by both participant groups.

Daily feedback conversations in EM are shaped by complex interpersonal and contextual factors. While learners and teachers recognize feedback as essential, fear of retaliation and systemic inefficiencies contribute to hesitancy in delivering constructive feedback. Addressing these barriers through faculty development, learner training in feedback literacy, and clear differentiation between mistreatment and feedback may foster safer, more effective learning environments.