A Qualitative Study of Attendings’ and Residents’ Perspectives on Feedback in Pediatrics Clinical Settings

Abstract

Although the role of context in various aspects of medical education has been highlighted as an area needing further research, to date few studies have explored how contextual factors shape feedback interactions within various clinical settings. Consequently, the purpose of this qualitative study was to explore how contextual factors shape feedback interactions within and across various clinical settings. In particular, this study explored the nature of feedback in inpatient and outpatient Pediatrics clinical settings from attendings’ and residents’ perspectives. Three research questions guided this study: (a) What are residents’ and attendings’ conceptions of feedback? (b) What contextual factors shape the nature of feedback interactions between residents and attendings? and (c) Which types of feedback interactions, if any, may be classified as dialogic feedback processes? An embedded single case-study design was used to study feedback interactions in four Pediatrics clinical settings (i.e., Ward, NICU, Ambulatory Clinic, and General Pediatrics Clinics). Direct observations, interviews, and researcher memos served as data sources. Twelve Pediatrics physicians participated in the study including four residents and eight attendings. Data analysis involved a three-step process of data analysis and presentation that used coding techniques (i.e., open coding and axial coding) from Strauss and Corbin’s (1990) approach to Grounded Theory coupled with situational mapping from Adele Clarke’s (2003) Situational Analysis. Findings suggest scheduling constraints, physical space, trusting relationships, and residents’ and attendings’ behaviours are contextual factors that can impact feedback interactions. Key contributions of this research include: (a) highlighting the relationships among forms of feedback, embedded feedback strategies, and existing models of feedback in medical education; (b) exploring the role of physical space as a possible barrier to feedback; (c) highlighting that residents may have narrower conceptions of feedback than attendings; (d) highlighting the distinction between practices related to structured and embedded feedback; (e) suggesting that due to constraints within different clinical settings, there is space for all models of feedback to coexist to support residents’ competence development; and (f) filling a gap in Pratt and colleagues’ (2006) study that highlighted how various contextual factors influenced residents’ competence development.