title: Investigating conditions for meaningful feedback in the context of an evidence-based feedback programme.
abstract: BACKGROUND
  We developed, implemented and evaluated an evidence-based programme of feedback designed to address limitations identified in the current literature.
  
  
  OBJECTIVE
  We sought to advance understanding about how and why feedback processes might be more effective in clinical education.
  
  
  METHODS
  Three faculty members and nine first-year internal medicine residents participated in the pilot programme. To counter challenges identified in the literature, feedback was based on direct observation, grounded in longitudinal faculty-resident relationships, and devoid of summative assessment. We used a qualitative case study design to address three research questions: (i) What benefits did the participants describe? (ii) What elements of the programme facilitated these benefits? (iii) What were the limitations and challenges of the programme? Collected data included audiotapes of interactions between faculty members and residents, field notes written during observations, and semi-structured interviews and focus groups with resident participants. Data analysis moved cyclically and iteratively through inductive and deductive analysis.
  
  
  RESULTS
  Residents described benefits relating to their ways of working (clinical skills), ways of learning (accountability for learning) and ways of feeling (emotional well-being). According to participants, specific elements of the programme that achieved these benefits included the direct observation of authentic clinical work, the longitudinal relationship with a faculty member and the emergence of feedback as a conversation between the faculty member and learner.
  
  
  CONCLUSIONS
  We conclude that the conditions established within our pilot feedback programme influenced the learning culture for first-year internal medicine residents by grounding direct observation in authentic clinical work and setting the observations in the context of a longitudinal, non-assessment-based relationship between a faculty member and resident. These conditions appeared to influence residents' participation in the feedback process, their ways of approaching their daily clinical work, their emotional well-being and their engagement in their own learning.
authors: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Stéphane
authors: S
authors: Voyer
authors: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Cary
authors: C
authors: Cuncic
authors: Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Deborah L
authors: DL
authors: Butler
authors: Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Kimberley
authors: K
authors: MacNeil
authors: Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors: Christopher
authors: C
authors: Watling
authors: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Rose
authors: R
authors: Hatala
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical; D005246:Feedback; D017144:Focus Groups; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards; D007396:Internship and Residency; D007858:Learning; D036301:Qualitative Research; D013663:Teaching / Q000592:standards