title: Learning culture and feedback: an international study of medical athletes and musicians.
abstract: OBJECTIVE
  Feedback should facilitate learning, but within medical education it often fails to deliver on its promise. To better understand why feedback is challenging, we explored the unique perspectives of doctors who had also trained extensively in sport or music, aiming to: (i) distinguish the elements of the response to feedback that are determined by the individual learner from those determined by the learning culture, and (ii) understand how these elements interact in order to make recommendations for improving feedback in medical education.
  
  
  METHODS
  Using a constructivist grounded theory approach, we conducted semi-structured interviews with 27 doctors or medical students who had high-level training and competitive or performance experience in sport (n = 15) or music (n = 12). Data were analysed iteratively using constant comparison. Key themes were identified and their relationships critically examined to derive a conceptual understanding of feedback and its impact.
  
  
  RESULTS
  We identified three essential sources of influence on the meaning that feedback assumed: the individual learner; the characteristics of the feedback, and the learning culture. Individual learner traits, such as motivation and orientation toward feedback, appeared stable across learning contexts. Similarly, certain feedback characteristics, including specificity, credibility and actionability, were valued in sport, music and medicine alike. Learning culture influenced feedback in three ways: (i) by defining expectations for teachers and teacher-learner relationships; (ii) by establishing norms for and expectations of feedback, and (iii) by directing teachers' and learners' attention toward certain dimensions of performance. Learning culture therefore neither creates motivated learners nor defines 'good feedback'; rather, it creates the conditions and opportunities that allow good feedback to occur and learners to respond.
  
  
  CONCLUSIONS
  An adequate understanding of feedback requires an integrated approach incorporating both the individual and the learning culture. Our research offers a clear direction for medicine's learning culture: normalise feedback; promote trusting teacher-learner relationships; define clear performance goals, and ensure that the goals of learners and teachers align.
authors.affiliation: Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Watling
authors.forename: Erik
authors.initials: E
authors.lastname: Driessen
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D001291:Attitude of Health Personnel; D004501:Education, Medical / Q000458:organization & administration*; D004522:Educational Status; D005180:Faculty, Medical; D030141:Feedback, Psychological; D006040:Goals; D006801:Humans; D007398:Interpersonal Relations; D007858:Learning; D009146:Music; D015279:Organizational Culture; D010820:Physicians / Q000523:psychology; D036301:Qualitative Research; D013177:Sports; D013337:Students, Medical / Q000523:psychology