Enhancing Feedback by Fostering Resident Feedback Literacy

Feedback from faculty to residents is a core teaching method in the competency-based model used in graduate medical education. Despite numerous efforts to improve faculty provision of feedback, the quantity and quality of feedback within graduate medical education training remains inadequate. Feedback literacy training attempts to enhance learners’ capabilities at seeking, understanding, and enacting feedback. This improvement study investigated feedback literacy within an Internal Medicine residency and studied whether a workshop on feedback literacy given to first year residents would improve the quality of feedback on subsequent clinical rotations. Over a six-month period, five feedback literacy workshops were given to first year residents in a single Internal Medicine residency program. Following each workshop, residents evaluated the quality of the workshop. Residents who consented to participate in the study completed pre and post workshop questionnaires on feedback literacy and participated in focus groups several months after the workshop. The focus groups discussed the impact of and barriers to employing feedback literacy behaviors in the clinical setting. Focus groups were transcribed, anonymized, and analyzed using provisional coding and thematic analysis. Residents reported a high degree of satisfaction with the quality of the workshop. First year Internal Medicine residents demonstrated high levels of feedback literacy prior to the workshop particularly in the areas of understanding feedback processes and valuing feedback. However, they were primarily passive in their approach to feedback. On post workshop questionnaires, attendees reported increased responsibility for their role in feedback processes. Analysis of focus group data revealed that use of feedback literacy behaviors led to more frequent and higher quality feedback and fostered a sense of empowerment in residents. The use of feedback literacy behaviors by residents also appeared to lower barriers that inhibit feedback provision by faculty. However, a subset of residents was reluctant to employ feedback literacy behaviors in the clinical setting. This improvement study demonstrates that offering first year Internal Medicine residents training in feedback literacy can improve feedback provision in the clinical setting and may foster enhanced learner agency. Future interventions should identify how to extend these benefits to all workshop participant