Improving Feedback From Residents to Preceptors: A Quality Improvement Project

Our objective was to implement a quality improvement project to improve the content and receipt of resident feedback using the nonviolent communication (NVC) rubric.

This project was conducted between 2018 to 2025 in a single family medicine residency (24 residents each year, 38 preceptors). Nonprecepting faculty members led small groups of residents through a process of converting raw feedback into the NVC format, which names the behavior, explains the resulting feelings, describes residents' needs, and requests continuing or changing the behavior. We analyzed how the feedback changed and conducted interviews with residents and preceptors to understand the value of the project.

We developed and refined the process over seven improvement cycles comprising 63 feedback sessions generating a total of 251 feedback statements. Within feedback sessions, the NVC process led to modification of behavior descriptions in 67.3% of cases, and provision of feelings descriptions increased from 23.3% prior to the process to 100% afterward. Final statements included 122 distinct needs words. Residents valued their agency and appreciated the protected group time to develop feedback. Preceptors respected the process, reported that it made them feel seen, reinforced valued behaviors, highlighted behaviors they did not realize were appreciated, and prompted them to evaluate their balance of resident teaching with patient safety.

We revised our method of collecting and presenting feedback from residents to their preceptors using the NVC approach. Resident and preceptor responses have been positive.