The Case for Feedback-in-Practice as a Topic of Educational Scholarship.

Abstract

The importance of clinical performance feedback is well established and the factors relevant to its effectiveness widely recognized, yet feedback continues to play out in problematic ways. For example, learning culture modifications shown to facilitate feedback have not seen widespread adoption, and the learner-educator interactions prescribed by research rarely occur organically. Nevertheless, medical learners achieve clinical competence, suggesting a need to expand educational scholarship on this topic to better account for learner growth. This Scholarly Perspective argues for a more extensive exploration of feedback as an educational activity embedded in clinical practice , where joint clinical work that involves an educator and learner provides a locus for feedback in the midst of performance. In these clinically embedded feedback episodes, learning and performance goals are constrained by the task at hand, and the educator guides the learner in collaboratively identifying problematic elements, naming and reframing the source of challenge, and extrapolating implications for further action. In jointly conducting clinical tasks, educators and learners may frequently engage in feedback interactions that are both aligned with workplace realities and consistent with current theoretical understanding of what feedback is. However, feedback embedded in practice may be challenged by personal, social, and organizational factors that affect learners' participation in workplace activity. This Scholarly Perspective aims to provide a conceptual framework that helps educators and learners be more intentional about and fully participatory in this important educational activity. By topicalizing this feedback-in-practice and exploring its integration with the more commonly foregrounded feedback-on-practice , future educational scholarship may achieve optimal benefit to learners, educators, and clinical practice.