Medical residents and attending physicians' perceptions of feedback and teaching in the United States: a qualitative study

Purpose: Residents and attendings agree on the importance of feedback to resident education. However, while faculty report providing frequent feedback, residents often do not perceive receiving it, particularly in the context of teaching. Given the nuanced differences between feedback and teaching, we aimed to explore resident and attending perceptions of feedback and teaching in the clinical setting. Methods: We conducted a qualitative study of internal medicine residents and attendings from December 2018 through March 2019 at a large US academic medical center (Massachusetts General Hospital) to investigate perceptions of feedback in the inpatient clinical setting. Residents and faculty were recruited to participate in focus groups. Data were analyzed using thematic analysis to explore perspectives and barriers to feedback provision and identification. Results: Five focus groups included 33 total participants in 3 attending (n=20) and 2 resident (n=13) groups. Thematic analysis of focus group transcripts identified 7 themes which organized into three thematic categories: (1) disentangling feedback and teaching, (2) delivering high-quality feedback, and (3) experiencing feedback in the group setting. Residents and attendings highlighted important themes in discriminating feedback from teaching. They indicated that while feedback is reactive in response to an action or behavior, teaching is proactive and oriented toward future endeavors. Conclusion: Confusion between the critical concepts of teaching and feedback may be minimized by allowing them to each have their intended impact, either in response to prior events or aimed toward those yet to take place.