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Letters to the Editor

Concrete Steps for Empowering Learners to Create a Feedback Environment

Wang, Flint Y. MD; Kogan, Jennifer R. MD

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doi: 10.1097/ACM.0000000000002251
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To the Editor:

Dr. Bing-You and colleagues1 recently presented an extensive and thorough review of 650 articles relating to feedback for learners. The published literature has increasingly focused on concerns from medical students and residents about receiving insufficient feedback,2,3 but almost all of these articles focus on equipping the teachers rather than the students. This perspective places the onus primarily on the teacher rather than the learner. We believe that if the learner believes he or she is receiving insufficient feedback, the learner can take the following five concrete steps to set up an environment conducive to delivering feedback.

  1. Give advance notice that you will request feedback. Letting the teacher know in the morning that you would like to discuss feedback in the afternoon may allow for more substantial and prepared feedback where time is carved out for the delivery.
  2. Ask for feedback from teachers who have witnessed you in action. If they have not, then make an opportunity for them to watch you perform patient care. If the teacher feels he or she has not observed enough to give substantial feedback, the student may then strategize with the resident about how to best display the learner’s skills in front of the attending evaluator.
  3. If the teacher does not have much feedback to offer, be ready to discuss prior feedback you have been given. To make the most of a meeting where only superficial compliments are given initially, the learner may summarize positive and negative feedback from the past to give the teacher a starting point for evaluating the learner.
  4. Be specific about areas you want to work on and how you will achieve them. This shows ownership by the learner and encourages the development of strategies that already have “buy-in.”
  5. If you ask for feedback, maintain a positive attitude once you receive it. Part of the hesitancy for teachers to give feedback is fear of a negative reaction to constructive feedback. Once the teacher senses the learner can respond professionally to feedback, continued sessions for feedback may occur with more ease and honesty.

Much like the curricula created to assist teachers with delivering feedback, we envision future studies focusing on evidence-based curricula to help learners elicit feedback. The above five steps may serve as a starting point for undergraduate and graduate medical education leaders to develop curricula to empower students and residents who are receiving inadequate feedback.

Flint Y. Wang, MD
Assistant professor of clinical medicine and co-leader, Organization and Efficiency Division, Clinical Coaching Committee, Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; [email protected]
Jennifer R. Kogan, MD
Professor of medicine, assistant dean of faculty development, and director, Undergraduate Medical Education, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.


1. Bing-You R, Hayes V, Varaklis K, Trowbridge R, Kemp H, McKelvy D. Feedback for learners in medical education: What is known? A scoping review. Acad Med. 2017;92:13461354.
2. Duffield KE, Spencer JA. A survey of medical students’ views about the purposes and fairness of assessment. Med Educ. 2002;36:879886.
3. Al-Mously N, Nabil NM, Al-Babtain SA, Fouad Abbas MA. Undergraduate medical students’ perceptions on the quality of feedback received during clinical rotations. Med Teach. 2014;36(suppl 1):S17S23.
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