127Many studies have shown the relative infrequency in which feedback is given in
medical education. Hewson et al. stated in a survey of residents that 8% were satis-
fied with the feedback they received. Approximately 80% of residents never or sel-
dom received corrective feedback from their attendings [ 33 ]. Studies in the operating
room have shown approximately 18% of residents reported attendings identifying
operative goals in the preoperative period. Additionally, only 37% of surgical
attendings discussed areas of improvement with the residents [ 36 ].
Barriers to Feedback
There appear to be several barriers to providing appropriate feedback. These barri-
ers can be broadly categorized into two groups: educator/teacher barriers and learner
barriers. Barriers that affect the educator/teacher include:
- Time constraints
- Lack of observation of the behavior or activity
- Desire to avoid upsetting the learner
- Feedback focus on person and personal qualities, rather than skill/task
With the contemporary time-intense focus on clinical responsibilities for teach-
ers, feedback for more junior residents is often left out or truncated. The teacher
needs to be present and observe the learner to accurately provide appropriate feed-
back. Additionally, constructive feedback might not be given due to the possibility
of creating an upsetting emotional response from the learner. Once the feedback is
given by the teacher, there is a dysfunctional tendency for the feedback to be
focused on the learner’s personal characteristics instead on the procedural skill
performed [ 32 ].
Barriers that affect the learner include insecurity, lack of growth mindset, and
insufficient foundational knowledge. Constructive feedback to the insecure resident
may be misinterpreted as being perceived as a bad resident. A resident that lacks the
mindset of growth or feels like they have no weaknesses is not receptive to receiving
feedback. Finally, a sufficient knowledge base in the area of knowledge or proce-
dural skill being demonstrated is necessary to comprehend the feedback given by
the teacher [ 32 ].
Giving Appropriate Feedback
To give appropriate feedback, a conducive environment must be first established.
This nonjudgmental environment should provide a relaxing, respectful atmosphere
for the learner to feel comfortable and fully engaged in the conversation. The learner
should also be notified ahead of time that he or she will be receiving feedback. It is
important for feedback to start with a self-assessment by the learner. This helps
7 Teaching Residents to Teach: Why and How