Promoting a Feedback Culture Part 2: The Feedback Relationship and Institutional Context
In Part 1 we reviewed the first six of 12 tips from a 2019 article ((MEDICAL TEACHER 2019, VOL. 41, NO. 6, 625–631) for how to create a feedback culture in our schools on the HSC campus, focusing on things that the feedback provider and the feedback recipient can do to facilitate this culture. In Part 2 we review the tips from this article about the specific feedback relationship and the institutional context in which feedback occurs.
Tip 7: Establish an educational alliance. This tip reinforces how important it is that we see feedback not as one-way delivery of advice from faculty to learner, but rather as a dynamic two-way partnership-based conversation. Think of it like this: 1) establish the relationship, 2) explore reaction, 3) check to understand the content, and 4) coach for growth. Behavior change is the outcome you are seeking as a result of this educational alliance.
Tip 8: Encourage teachers and learners to co-create learning opportunities for behavior change. Creating a learning environment conducive to effective goal setting, observation by the faculty, feedback conversation is the goal here. The summary…learners initiate, teachers facilitate. The starting point is learner initiation and engagement.
Tip 9: Ensure appropriate attention to learner self-efficacy. Many of us are reluctant to provide constructive feedback to learners for fear of damaging their self-esteem. Learners need to confront their knowledge and skills gaps before they can change behaviors. By providing formative assessment (in the moment, coach-like feedback) to learners can help them balance the negative feelings from constructive feedback with the increase in self-esteem resulting from reinforcing feedback. This could increase their acceptance of constructive feedback. Learners need us to deliver constructive feedback if they are to develop along their learning continuum toward independent practice.
Tip 10: Promote optimal balance of supervision and autonomy. Patient safety and quality concerns need to be balanced with learner autonomy in our healthcare environments in which patient care and learning happen concurrently. Consider a supervision continuum that starts with full external (faculty) guidance, advances to shared guidance, and finally full internal (learner) guidance. This requires an ongoing dialog, monitoring of progress, and adapting teaching to learning needs. This is complicated in our current academic healthcare environment in which in any given month of service the learner is likely supervised by multiple attending faculty. Anything the makes the faculty engagement more longitudinal will help this process.
Tip 11: Establish a continuous practice improvement environment. By taking this approach and applying it to learners at all levels, including the faculty, the institution can normalize the expectation that we are all on a continuous practice improvement journey. One way institutions can help is to adopt a formative evaluation process similar to the Plus Delta approach developed by the Lean Construction Institute. If we are willing to acknowledge and model continuous practice improvement, our unit will promote a feedback culture, because without feedback there can be no improvement of ourselves as individuals or our systems of care.
Tip 12: Emphasize a feedback culture that enhances professional growth. There are several components to put this tip into play: 
Emphasize specific guidelines for ongoing formative feedback
Create a learning environment that normalizes continuous practice improvement for both learners and teachers
Develop longitudinal relationships with learners
Observe performance directly
Encourage feedback-seeking by both learners and teachers
Train learners and teachers in how to have goal-directed and actionable feedback conversations
The Royal College of Physicians and Surgeons of Canada recommends a coaching approach by teachers (https://www.royalcollege.ca/rcsite/cbd/implementation/wbas/coaching-and-cbd-e) that should be considered for faculty development.
We encourage you to take a close look at this well-referenced manuscript so you can begin to do your part as an educator to bring the UoL HSC schools forward as a feedback culture. Just imagine what might happen if we all began to work on this at the individual and system level on our journey to make UofL a Great Place to Work, Learn and Invest.
References:
1. Ramani, S., Könings, K. D., Ginsburg, S., & van der Vleuten, C. P. (2018). Twelve tips to promote a feedback culture with a growth mindset: Swinging the FEEDBACK pendulum from recipes to relationships. Medical Teacher, 41(6), 625–631. https://doi.org/10.1080/0142159x.2018.1432850
2. Cbd and coaching. Coaching and CBD:: The Royal College of Physicians and Surgeons of Canada. (n.d.). Retrieved September 23, 2021, from https://www.royalcollege.ca/rcsite/cbd/implementation/wbas/coaching-and-cbd-e.