Competency-based medical education and programmatic assessment intend to increase the opportunities for meaningful feedback, yet these conversations remain elusive. By comparing resident and faculty perceptions of feedback opportunities within one internal medicine residency training program, we sought to understand whether and how principles underlying meaningful feedback could be supported or constrained across a variety of feedback opportunities. Using case-study qualitative methodology, interviews and focus groups were conducted to explore 19 internal medicine residents’ and 7 faculty members’ perceptions of feedback across a variety of feedback opportunities: coaching, mini-CEXs, in-training evaluation reports and routine clinical supervision. Our data analysis moved iteratively between developing conceptual understandings and fine-grained analyses, while attending to both deductive and inductive analysis. Our results suggest that all feedback opportunities, including those created through formalized assessments, can foster meaningful feedback if faculty establish a trusting relationship with the resident, base their feedback on direct observation and support resident learning. However, formalized assessments were often perceived as inhibiting the conditions for meaningful feedback. A coaching program provided a context in which meaningful feedback could arise, in part because faculty were supported in shifting their focus from patient to resident. Meaningful feedback in clinical education may be fostered across a variety of feedback opportunities, however, it is often constrained by assessment. We must consider whether increasing the frequency of formative assessments may inhibit efforts to improve our feedback cultures while, in contrast, freeing up faculty to focus on supporting resident learning could improve these cultures.

中文翻译：

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必要但不充分：确定内科住院医师临床教育有效反馈的条件

基于能力的医学教育和计划评估旨在增加获得有意义反馈的机会，但这些对话仍然难以捉摸。通过比较住院医师和教职员工对一个内科住院医师培训计划中反馈机会的看法，我们试图了解是否以及如何在各种反馈机会中支持或限制有意义的反馈背后的原则。使用案例研究定性方法，通过访谈和焦点小组探讨了 19 名内科住院医师和 7 名教职员工对各种反馈机会的反馈看法：辅导、迷你 CEX、培训评估报告和常规临床监督. 我们的数据分析在发展概念理解和细粒度分析之间反复移动，同时参与演绎和归纳分析。我们的结果表明，如果教师与住院医师建立信任关系，将他们的反馈建立在直接观察的基础上并支持住院医师学习，那么所有反馈机会，包括通过正式评估创造的机会，都可以促进有意义的反馈。然而，正式的评估常常被认为阻碍了有意义反馈的条件。辅导计划提供了一个可以产生有意义反馈的环境，部分原因是支持教师将注意力从患者转移到住院医生。可以通过各种反馈机会促进临床教育中有意义的反馈，但是，它常常受到评估的限制。我们必须考虑增加形成性评估的频率是否会抑制我们改善反馈文化的努力，而相反，让教职员工专注于支持居民学习可以改善这些文化。