Exploring Faculty Approaches to Feedback in the Simulated Setting: Are They Evidence Informed?

Introduction: Feedback in clinical education and after simulated experiences facilitates learning. Although evidence-based guidelines for feedback exist, faculty experience challenges in applying the guidelines. We set out to explore how faculty approach feedback and how these approaches align with current recommendations.

Methods: There is strong evidence for the following four components of feedback: feedback as a social interaction, tailoring content, providing specific descriptions of performance, and identifying actionable items. Faculty preceptors participated in feedback simulations followed by debriefing. The simulations were video recorded, transcribed, and analyzed qualitatively using template analysis to examine faculty approaches to feedback relative to evidence-informed recommendations.

Results: Recorded encounters involving 18 faculty and 11 facilitators yielded 111 videos. There was variability in the extent to which feedback approaches aligned with recommended practices. Faculty behaviors aligned with recommendations included a conversational approach, flexibly adapting feedback techniques to resident context, offering rich descriptions of observations with specific examples and concrete suggestions, achieving a shared understanding of strengths and gaps early on to allow sufficient time for problem-solving, and establishing a plan for ongoing development. Behaviors misaligned with guidelines included prioritizing the task of feedback over the relationship, lack of flexibility in techniques applied, using generic questions that did not explore residents' experiences, and ending with a vague plan for improvement.

Conclusions: Faculty demonstrate variability in feedback skills in relation to recommended practices. Simulated feedback experiences may offer a safe environment for faculty to further develop the skills needed to help residents progress within competency-based medical education.