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Medical Student Perceptions of Feedback and Feedback Behaviors Within the Context of the “Educational Alliance”

Bowen, Lucy; Marshall, Michelle PhD; Murdoch-Eaton, Deborah MBBS, FRCPCH, MD

doi: 10.1097/ACM.0000000000001632
Research Reports

Purpose Using the “educational alliance” as a conceptual framework, the authors explored medical students’ beliefs about feedback and how their feedback behaviors reflect their perceptions.

Method Five focus groups (four to six medical students each) at one UK medical school in 2015 were used to capture and elucidate learners’ feedback perceptions and behaviors within the context of the learner–educator relationship. A map of key feedback opportunities across the program was used as a tool for exploring student engagement with the feedback process. Qualitative data were analyzed using an approach based on grounded theory principles.

Results Three learner feedback behaviors emerged: recognizing, using, and seeking feedback. Five core themes influencing these behaviors were generated: learner beliefs, attitudes, and perceptions; relationships; teacher attributes; mode of feedback; and learning culture. Conceptual models illustrating the relationships between the themes and each behavior were developed. Learning culture influenced all three behaviors with a wide context of influences.

Conclusions Ensuring that feedback leads to improved performance requires more than training educators in best practices. The conceptual models support the educational alliance framework and illustrate the context and complexity of learning culture surrounding the educational relationship, learner, and feedback exchange. The educational alliance approach is underpinned by a mutual understanding of purpose and responsibility. Enhancing learners’ feedback literacy skills seems to be the key aspect of the educational alliance in need of attention. Empowering learners to recognize, seek, and use feedback received within diverse learning cultures is essential.

Supplemental Digital Content is available in the text.

L. Bowen was a science graduate intern and research assistant, Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom, at the time of the study.

M. Marshall is director of learning and teaching, Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom.

D. Murdoch-Eaton is dean of medical education and departmental head, Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom.

Supplemental digital content for this article is available at

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Ethical approval for the study was granted by the University of Sheffield’s ethical review board (Ref: 002788).

Previous presentations: Presented at AMEE 2016; Barcelona, Spain; September 2016.

Correspondence should be addressed to Deborah Murdoch-Eaton, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK; telephone: (+44) 114-222-5546; e-mail:

© 2017 by the Association of American Medical Colleges