Harnessing student feedback to transform teachers: Role of emotions and relationships.

Introduction: Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional development.

Methods: In this cross-sectional qualitative study based on a constructivist paradigm, 14 medical teachers individually drew a Rich Picture (RP) of a feedback experience in which they received informal or formal feedback from students, resulting in a personal or professional change. After the drawing, we interviewed the participants to deepen our understanding of teachers' experiences. We analysed the drawings and interview transcripts using an iterative process of thematic analysis.

Results: SF that culminated in personal or professional change is a highly emotional experience for teachers, often with long-lasting consequences. It may threaten or reassure their self-concept and professional identity, generating feedback avoidance or feedback-seeking behaviour. SF is particularly powerful in transforming teaching practices when teachers feel connected to students through an honest and constructive relationship. Remarkably, some teachers intentionally build relationships with certain (selected) students to get 'qualified' feedback. SF acceptance also increases when teachers are open to receiving feedback and there is an institutional culture that values feedback. Finally, medical teachers believe that formal (planned) feedback is relevant to improve the curriculum, while informal (spontaneous) feedback is important for promoting teachers' personal and professional development.

Discussion: SF has the potential to become a transformative learning experience for teachers. The student-teacher relationship and teachers' emotional reactions affect the way teachers make sense of and internalise SF and enact behavioural change. Understanding the complexity surrounding SF is vital for supporting teachers in seizing opportunities for growth and in nurturing a meaningful relationship with the act of teaching.