Background: Feedback and teaching are critical to the development of clinical skills. Although they occur with regularity on medical wards, learners infrequently recognize them (Kogan et al. 2000). Feedback has been defined as providing information related to a learner’s performance that is intended to guide future thinking and behavior (Ende 1983, Shute 2008); while teaching has been defined as the “intentional act of providing information and instruction to learners based on identified learning needs” (Farlex 2012). Although these concepts overlap significantly, little work has explored how learners perceive and differentiate between them, particularly when they co-occur in clinical medicine. This study utilized clinical scenarios to examine whether residents are able to identify feedback and teaching on the inpatient medicine wards.
Methods: A resident observed new patient rounds on the inpatient medicine teaching service for two weeks and took notes on instances of teaching and feedback that fit the aforementioned definitions. Three leaders in medical education were utilized to identify 10 scenarios that were unambiguously teaching, feedback, both, or neither. Seven of these scenarios were incorporated into a survey with demographic information and sent to internal medicine residents across the country. The scenarios included two scenarios representing teaching, two of feedback, and three scenarios that represented both teaching and feedback.
Results: At this early point in data collection, representatives from six residencies have participated. Participants were on average 29.1 (SD 2) years old , about half were women (90/174, 51%), and three-quarters had no formal teaching experience (130/175, 74%). The majority of participants were able to identify each of the two purely feedback scenarios (167/175, 95% and 162/175, 93%), and 89% (157/175) were able to correctly identify both feedback scenarios. Participants were slightly less consistent with purely teaching scenarios (127/175, 73% and 156/175, 89%; 117/175, 67% both). Only 36% of residents (63/175) were able to correctly identify all three scenarios that represented both feedback and teaching. The ability to identify one scenario with both feedback and teaching was inversely correlated with year in training (p=0.008). Residents with formal teaching experience were not more likely to correctly identify feedback, teaching, or both.
Conclusions: While residents are good at identifying isolated instances of feedback, they are less able to identify isolated instances of teaching, and they struggle to discern when feedback and teaching occur together. Given that a significant proportion of medical training happens via in-the-moment, combined feedback and teaching, identifying these concepts in practice is critical for resident learning. In our future work, we will consider how to improve resident perception of feedback and teaching in order to improve clinical performance.