519 - Feedback in Clinical Medical Education: Then vs. Now

Feedback: one of the most difficult, yet necessary, topics in medical education. Who provides it? Who seeks it? How do we best communicate it? Nearly 40 years ago, Dr. Jack Ende asked these same questions. His observations in 1983 offered a framework for medical educators, highlighting the critical role of feedback in the educational process for medical students and residents.

Objective:

As the 40th anniversary of his seminal paper approaches, our questions remain: what methods and viewpoints have withstood the test of time, and conversely, what has changed? To provide modern-day comparison, we analyzed discussions from podcast episodes.

Design/Methods:

We performed a qualitative study, comparing text related to feedback in the article “Feedback in Clinical Medical Education” by Dr. Ende to discussions on feedback in the Teaching in Medicine podcast interviews from 2020. We conducted a thematic analysis of the two data sets.

Results:

Of the 24 Teaching in Medicine podcast episodes totaling 12 hours and 8 minutes of content, 41 minutes and 28 seconds were spent discussing feedback (5.7%). In reviewing the podcast episodes, the statements related to feedback were divided into 139 data points, and then into 16 codes based on similarities of data points. Similarly, 87 data points were extracted from Dr. Ende’s paper, and then organized into 14 codes. Of the podcast codes, frequency/timing of feedback was mentioned the most (n=43), followed by effective feedback tips (n=40). On the contrary, from Dr. Ende’s paper, the impact of lack of feedback (n=19) and background/definition of feedback (n = 11) were mentioned most.

Conclusion(s):

In the 1980s, the case for feedback was just being made with a focus on the lack of feedback given. The conversation of feedback has changed with time, with new ideas explored in 2020. These topics include the importance of bi-directional feedback, interaction with patients and role modeling. These highlight that feedback involves three parties: the educator, the learner, and the patient. The idea of an educator both giving and receiving feedback was novel and speaks, perhaps, to a less hierarchal structure in modern academic medicine. Furthermore, certain aspects have withstood the test of time, with optimal timing of feedback and providing a safe environment discussed both then and now. This study reinforces that feedback in clinical medical education has gained momentum and is now considered a standard. It highlights its continued evolution with more physicians speaking on the topic. Forty years from now, what will clinical feedback look like and will it continue to evolve?