Feedback Conversations Research Articles

"Praise in Public; Criticize in Private": Unwritable Assessment Comments and the Performance Information That Resists Being Written.

Written assessment comments are needed to archive feedback and inform decisions. Regrettably, comments are often impoverished, leaving performance-relevant information undocumented. Research has focused on content and supervisor's ability and motivation to write it but has not sufficiently examined how well the undocumented information lends itself to being written as comments. Because missing information threatens the validity of assessment processes, this study examined the performance information that resists being written. Two sequential data collection methods and multiple elicitation techniques were used to triangulate unwritten assessment comments. Between November 2022 and January 2023, physicians in Canada were recruited by email and social media to describe experiences with wanting to convey assessment information but feeling unable to express it in writing. Fifty supervisors shared examples via survey. From January to May 2023, a subset of 13 participants were then interviewed to further explain what information resisted being written and why it seemed impossible to express in writing and to write comments in response to a video prompt or for their own "unwritable" example. Constructivist grounded theory guided data collection and analysis. Not all performance-relevant information was equally writable. Information resisted being written as assessment comments when it would require an essay to be expressed in writing, belonged in a conversation and not in writing, or was potentially irrelevant and unverifiable. In particular, disclosing sensitive information discussed in a feedback conversation required extensive recoding to protect the learner and supervisor-learner relationship. When written comment requests to document performance information are viewed as an act of disclosure, it becomes clear why supervisors may feel compelled to leave some comments unwritten. Although supervisors can be supported in writing better assessment comments, their failure to write invites a reexamination of expectations for documenting feedback and performance information as written comments on assessment forms.

"I Think Many of Them Want to Appear to Have a Growth Mindset": Exploring Supervisors' Perceptions of Feedback-Seeking Behavior.

Feedback seeking is an expected learner competency. Motivations to seek feedback are well explored, but we know little about how supervisors perceive such requests for feedback. These perceptions matter because how supervisors judge requests can affect the feedback they give. This study explores how supervisors perceive and attribute motivations behind feedback requests to better understand the benefits and hazards of feedback seeking. Constructivist grounded theory was used to interview supervisors at the Temerty Faculty of Medicine, University of Toronto, from February 2020 to September 2022. Supervisors were asked to describe instances when they perceived feedback requests as being sincere or insincere, what led to their opinions, and how they responded. Transcripts were analyzed and coded in parallel with data collection; data analysis was guided by constant comparison. Seventeen faculty were interviewed. Participants perceived 4 motivations when learners sought feedback: affirmation or praise; a desire to improve; an administrative requirement, such as getting forms filled out; and hidden purposes, such as making a good impression. These perceptions were based on assumptions regarding the framing of the initial request, timing, preexisting relationship with the learner, learner characteristics, such as insecurity, and learner reactions to feedback, particularly defensiveness. Although being asked for feedback was generally well received, some participants reported irritation at requests that were repetitive, were poorly timed, or did not appear sincere. Feedback seeking may prompt supervisors to consider learners' motivations, potentially resulting in a set of entangled attributions, assumptions, and reactions that shape the feedback conversation in invisible and potentially problematic ways. Learners should consider these implications as they frame their feedback requests and be explicit about what they want and why they want it. Supervisors should monitor their responses, ask questions to clarify requests, and err on the side of assuming feedback-seeking requests are sincere.

Feedback, learning and becoming: Narratives of feedback in complex performance challenges.

Becoming a general practitioner (or family medicine specialist) is challenging, as traineeslearn to manage complex and ambiguous situations. Feedback is a key component of this learning. Although research has tended to focus on feedback's momentary processes and impacts, there is value in seeking to understand the work it does over time and how trainees position themselves across multiple feedback encounters. We ask: how do newly qualified GPs narrate themselves and their experiences with complex performance challenges? Within these narratives, what is the role of feedback? The research adopts a holistic and sequential narrative analysis approach, with in-depth narrative interviews of 16 general practice trainees who had just completed their training requirements. The analysis involved restorying the participant narratives chronologically. Each narrative formed a unit of analysis where narrative commonalities across plots, characters, emotions and the role of feedback were interpreted. Four plotlines within GP trainees' stories of complex performance challenges were identified: Journeyperson, Hero's Quest, Solo Journeyer and Endless Struggle. Trainees, supervisors and feedback are positioned differently within these plotlines. Narratives were saturated with emotions. The plotlines bring together an alternative way of understanding how feedback, learning and becoming are woven together. They illustrate how multiple interactions with patients, supervisors, peers and systems thread together into an overall trajectory. How a trainee positions themselves as protagonists and who they characterise as their antagonists can help direct the focus of supervisors' feedback conversations.

Quality-of-life and beliefs about medication in relation to a therapy adherence intervention in resistant hypertension: the Resistant HYpertension: MEasure to ReaCh Targets trial.

To assess the impact of personalized feedback on therapy adherence testing results on quality of life and beliefs about medication in patients with resistant hypertension, as well as to identify patient-oriented predictors of therapy adherence. This study was a prespecified post hoc analysis of the multicenter randomized controlled trial Resistant HYpertension: MEasure to ReaCh Targets (RHYME-RCT). Patients were randomized to a personalized feedback conversation on measured antihypertensive drug levels additional to standard-of-care, or standard-of-care only. The primary outcomes consisted of EuroQol EQ-5D-5L and Beliefs about Medicine Questionnaire (BMQ) scores at 12 months. A total of 56 patients with median age 61.5 [25th-75th percentile: 55.8-69.3] years (21.4% women) were included. Mean blood pressure ±SD was 149.8/84.1 ± 14.9/13.8 mmHg while being on a median of 5.6 [4.8-7.3] defined daily dosages (DDD) of antihypertensive drugs. At 12 months, no differences were observed in EQ-5D-5L index (0.81 [0.69-0.89] vs. 0.89 [0.73-1.00]; P = 0.18) and visual analogue scale score on general patient-perceived health (70 [60-80] vs. 70 [60-82]; P = 0.53) between the intervention-arm and the standard-of-care only-arm. Likewise, individual EQ-5D-5L domain scores and BMQ scores did not differ between both arms. Irrespective of the intervention, independent positive predictors of the percentage adherence were patient age, EQ-5D-5L index score, BMQ-specific necessity score and concern score, whereas the total number of drugs prescribed was a negative predictor. Within this prespecified subanalysis of the randomized RHYME-RCT trial, implementation of a personalized feedback conversation targeting therapy adherence did not improve health-related quality-of-life and beliefs about medication in patients with resistant hypertension.

Not so simple: evaluating consequences validity evidence for a workplace-based assessment in surgery

PurposeWorkplace-based assessments (WBAs) of trainee operative skills are widely used in surgical education as formative assessments to facilitate feedback for learning, but the evidence to support this purpose is mixed. Further evaluation of the consequences of assessment use and score interpretation is needed to understand if there is alignment between the intended and actual impacts of assessment. This study examines consequences validity evidence for an operative WBA, exploring whether WBA use is consistent with the goals of formative assessment for learning.MethodsEight residents and 9 faculty within the Department of Otolaryngology—Head and Neck Surgery at a tertiary institution completed semi-structured interviews after participating in a pilot of a surgical WBA, the System for Improving and Measuring Procedural Learning in the OR (SIMPL OR). Residents received feedback from attendings via both scores (performance and autonomy ratings) and recorded dictations. Interview questions explored faculty and resident perceptions of feedback behaviors and perceived impacts on their teaching or learning practices. Three researchers analyzed transcripts using directed qualitative content analysis to generate themes and evaluated how the perceived impacts aligned with formative purposes for assessment and score use.ResultsBoth faculty and residents identified intended impacts of formative assessment, including (1) greater emphasis on feedback, (2) support for a postoperative feedback routine, and (3) facilitation of case-specific reflection. Residents also used score and verbal feedback for (1) calibrating case perceptions and (2) benchmarking performance to an external standard. The recorded dictations supported feedback by (1) providing context for ratings, (2) facilitating review of dictated feedback, and (3) prompting faculty for deliberate feedback. Unintended impacts included: (1) emotional discomfort during the assessment process, (2) increased feedback frequency but not diversity or quality, (3) inadequate support for feedback conversations, and (4) limited next steps for teaching or learning. Assessment usage declined over the pilot period.ConclusionsThe validity evidence gathered in this study suggests an operative WBA can be used for formative purposes to improve perceptions of feedback, but unintended consequences and implementation challenges limited ultimate impacts on teaching and learning. User perspectives can add important elements to consequences validity evidence and should be further evaluated in different implementation settings to better understand how WBAs can achieve their formative goals.

The effects of interim feedback on perceptions and outcomes of assessment in a first-year history course

ABSTRACT Research on the first year of higher education (FYHE) has shown that students benefit from scaffolding to ease the transition to university. Constructively aligned assessment and feedback are integral to a scaffolded approach. Low-stakes interim assessments and feedback can reduce uncertainties around higher-stakes assessments and help students meet key learning outcomes. This small-scale study investigated the effects of one-on-one interim feedback conversations (FCs) with students in a first-year modern history course. Two datasets were used and compared. First, the students were surveyed about their perspectives on FCs after they took place. Second, analytics data provided insights into engagement and assessment performance across the cohort. Considering these datasets alongside each other suggests that FCs, though a popular and beneficial feedback mode, are unlikely to override other known success factors. However, the positive reception and apparent benefits of FCs make them a viable option for implementing interim feedback in the FYHE.

Exploring the marking of a reflective assessment task: a collaborative autoethnography by educators navigating Indigenous allyship in higher education

ABSTRACT The aim of this study was to closely examine the experiences of non-Indigenous academics in marking a single assessment task designed to promote cultural safety practice in a health professional programme. In recognition of institutional racism and significant health and wellbeing disparity in Indigenous wellbeing, cultural safety is recognised as essential knowledge across professions in tertiary education. An assessment task was designed to support students’ written critical reflection to promote their cultural safety practice. A collaborative autoethnography by four academics critically reflected on the tensions in marking this reflective assignment as non-Indigenous educators. Thematic analysis was conducted on transcriptions of the authors’ discussions and a framework was developed in response to repeating sites of tension. The Indigenous allyship assessment framework: sharing the load was framed around the central theme of Navigating the Unsettling. It specifically draws attention to navigating the Personal (Heightened Responsibility and Partial Knowledge), Pedagogical ( Judge the Meaningful and Feedback Conversations) and Persons and Processes (systems) (Efficiency Culture and Cost of Marking) tensions. Our conclusion was that non-Indigenous educators need to consciously navigate unsettling challenges to do justice to assessment tasks to promote cultural safety.

Challenges in engaging patients in feedback conversations for health care professionals' workplace learning.

Patient feedback is relevant information for improvement of health care professionals' performance. Engaging patients in feedback conversations can help to harness patient feedback as a powerful tool for learning. However, health care settings may prevent patients and health care professionals to effectively engage in a feedback dialogue. To advance our understanding of how feedback conversations may support learning in and from practice, we sought to explore patients' and health care providers' perspectives on engaging patients in feedback conversations as informal learning opportunities. For this qualitative study, we used a pragmatic approach and conducted semi-structured interviews with 12 health care providers and 10 patient consultants. We applied an inductive approach to thematic analysis to understand interviewees' perceptions regarding patient feedback for workplace learning. Participants attributed importance to patient feedback and described how the feedback may improve treatment relationships, professionals' performance and care processes on the team level and the organisational level. Participants experienced conflicting roles as patient and educator or expert and learner, respectively. Changing relationships, feelings of vulnerability and perceived power dynamics in treatment relationships would affect participants' engagement in feedback conversations. Patients and professionals alike saw a role for themselves in giving or inviting feedback but often missed the tools for engaging in feedback conversations. Patient feedback can contribute to professionals' practice-based learning but requires navigating tensions around conflicting roles and power dynamics in the treatment relationship. Both patients and health care professionals need to embrace vulnerability and may need facilitation and guidance to use patient feedback effectively. Attention to power dynamics, if not a shift towards collaborative relationships, is however crucial to engage patients in feedback conversations, thereby capitalising the power patients posses.

Fairer feedback – enhancing feedback conversations between those from diverse backgrounds

Fairer feedback – enhancing feedback conversations between those from diverse backgrounds

What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine.

The Master Adaptive Learner (MAL) model postulates that learners develop adaptive expertise through cycles of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors of MALs are not well characterized. We sought to define behaviors that characterize MALs within emergency medicine (EM) training. Using a constructivist grounded theory approach, we analyzed semistructured interviews with expert EM educators. These experts reflected on observable behaviors as well as factors in the clinical learning environment that may modulate these behaviors. We recruited using purposive sampling until thematic saturation. We identified four overall themes, of which three described groups of learner behaviors and a fourth described modifiers of these behaviors. Learner behaviors include: (1) critical interrogation of practice, (2) intellectual risk-taking, and (3) intentional curation of a learning network. Critical interrogation of practice encompasses several observable behaviors including learner-driven feedback conversations, independent synthesis of clinical information, appropriate deviation from algorithms based on their conceptual understanding of core principles, intentional use of case variation and hypothetical questioning, and continuous refinement of decisions. MALs also engage in intellectual risk-taking for their development by communicating clinical decision-making processes even at the risk of being wrong, openly addressing errors and gaps, and intentionally seeking out uncomfortable experiences. Intentional curation of a learning network is the deliberate development of a consortium of trusted individuals who serve as mentors and sounding boards. We also identified a fourth theme related to the expression of learner behaviors: learning environment modulates behaviors. Active promotion of psychological safety is necessary for learners to express these behaviors. This safety is mediated through trusting relationships and expert supervisors who serve as colearners and role models. We present several behaviors that allow identification of MALs among EM trainees. These data expand our understanding of MALs and the critical influence of the learning environment. Identification of these behaviors may allow for more precise categorization of targeted curricular interventions and meaningful learning outcomes.

Taking the Fear Out of Peer Feedback: A Brain-Friendly Peer Feedback Program.

Effective peer feedback is critical for the self-regulation of nursing practice and safe, high-quality care, yet peer feedback conversations can be challenging and anxiety provoking. As current literature revealed no consistent approach, taskforce members designed and implemented an innovative and standardized peer feedback program using brain science to support nurses' skills in speaking up. The new program resulted in an increase in nurses' self-reported willingness to provide peer feedback, and improvements in safety culture and nurse-sensitive quality outcomes.

(HR) Manager in the Hot Seat: An Exercise to Practice Delivering (and Receiving) Performance Feedback

Performance conversations are a critical and necessary part of performance management. Feedback is most effective when it is constructive and when it involves a dialogue rather than a monologue, but people often struggle with this skill. This activity includes an experiential exercise that applies a five-part process for performance feedback, appropriate for human resources, conflict management, and/or organizational behavior classes. Students identify performance-based issues, create a plan to address the issues, craft an email to their employee requesting a meeting, meet with and engage in a performance feedback conversation, and develop an improvement plan collaboratively with the employee. “Managers” and “employees” reflect on the effectiveness of the performance conversation. This five-part exercise can be used in an undergraduate- or graduate-level course. Recommendations for adapting the exercise to the online environment are included.

Between teacher candidates’ reflection and teacher educators’ evaluation: Fluctuations in epistemic (a)symmetry in feedback conversations

AbstractEvidence‐based reflective practices are promoted in all recent frameworks for language teacher education (LTE). Through dialogic evidence‐based feedback sessions, reflectional sequences make trainees join a virtuous cycle in which they reconsider and readjust their methods of teaching. However, research into how mentor and trainees orient to this evidence in interaction remains scarce. With this need in mind, this study investigates post‐observation conversations (POCs) in a language teaching practicum. The recordings of 17 video‐mediated POCs are sequentially and functionally analyzed using multimodal conversation analysis. The data suggests that the fluctuations in knowledge (a)symmetries serve as a catalyst for the progression of reflection‐ and evaluation‐oriented sequences. The mentors strategically downgrade their epistemic position to index the trainees’ experiential knowledge and invite reflection. However, when mentors initiate evaluation‐oriented sequences, they systematically insert their epistemic primacy to limit any potential resistance that would challenge their epistemic authority to evaluate. The video medium also creates unique multimodal opportunities for their mutual orientation to evidence. The findings are conducive to expanding research into reflective practice in LTE and have pedagogical and research implications for our understanding of the sequential and relational organization of epistemics in feedback conversations.

The Mediating Impact of Goal–Role Clarity on the Relationship between Feedback–Seeking Behavior and Goal Orientations with Job Satisfaction Intrinsic Cognitions and Person–Organization Fit

This study aims to offer a design for the cognitive calibration of employees’ work behaviors. The study focuses on fostering sustainable behavioral patterns in the workplace by arguing that, to sustain the cognitive maintenance of workplace behaviors, the nexus between self-efficacy behaviors, ability beliefs, job–role clarity, and employees’ perceived alignment should be considered during human resource (HR) processes and events, such as feedback conversations and performance reviews. The tool used to collect our data was a questionnaire administered both in paper format and digitally through an online platform compliant with European data protection regulations, to 210 professionals from two IT companies in northeastern Romania (n = 116 for the first sample and n = 94 for the second sample). The series of questions included Likert scales addressing frequency, (dis)agreement, and clarity. The model was tested using SPSS v.27 and SMART-PLS v.4 software, and the study used partial least squares structural equation modeling to examine the proposed hypotheses. Findings for Study 1 indicated that role clarity partially mediated the relationship between feedback–seeking and job cognitions whilst fully mediating the effect on person–organization fit. Results from Study 2 indicated that role clarity partially mediated the relationship between goal orientations and job cognitions and fully mediated the effect on person–organization fit. Therefore, it is possible to aid employees’ in storing their employment narratives in coherent cognitive schemas while elevating their assessment of work values’ alignment and meaningfulness. On this basis, effective tools and methodologies should be made available to employees, at the individual and team level, to help them understand the cognitive processing endorsing workplace behavioral patterns, compatibility, and causality for them to sustainably transform their workplace behavior.

Developing residents' feedback literacy in emergency medicine: Lessons from design-based research.

Residents in emergency medicine have reported dissatisfaction with feedback. One strategy to improve feedback is to enhance learners' feedback literacy-i.e., capabilities as seekers, processors, and users of performance information. To do this, however, the context in which feedback occurs needs to be understood. We investigated how residents typically engage with feedback in an emergency department, along with the potential opportunities to improve feedback engagement in this context. We used this information to develop a program to improve learners' feedback literacy in context and traced the reported translation to practice. We conducted a year-long design-based research study informed by agentic feedback principles. Over five cycles in 2019, we interviewed residents and iteratively developed a feedback literacy program. Sixty-six residents participated and data collected included qualitative evaluation surveys (n = 55), educator-written reflections (n = 5), and semistructured interviews with residents (n = 21). Qualitative data were analyzed using framework analysis. When adopting an agentic stance, residents reported changes to the frequency and tenor of their feedback conversations, rendering the interactions more helpful. Despite reporting overall shifts in their conceptions of feedback, they needed to adjust their feedback engagement depending on changing contextual factors such as workload. These microsocial adjustments suggest their feedback literacy develops through an interdependent process of individual intention for feedback engagement-informed by an agentic stance-and dynamic adjustment in response to the environment. Resident feedback literacy is profoundly contextualized, so developing feedback literacy in emergency contexts is more nuanced than previously reported. While feedback literacy can be supported through targeted education, our findings raise questions for understanding how emergency medicine environments afford and constrain learner feedback engagement. Our findings also challenge the extent to which this contextual feedback know-how can be "developed" purposefully outside of the everyday work.

Relay and Feedback Conversion Effect of Hydrocarbons between ZSM-5 Grains on Product Selectivity and Coke Formation during Methanol Aromatization

Relay and Feedback Conversion Effect of Hydrocarbons between ZSM-5 Grains on Product Selectivity and Coke Formation during Methanol Aromatization

Exploring the Impact of Entrustable Professional Activities on Feedback Culture: A Qualitative Study of Anesthesiology Residents and Attendings.

Entrustable professional activities (EPAs) were introduced as a potential way to optimize workplace-based assessments. Yet, recent studies suggest that EPAs have not yet overcome all of the challenges to implementing meaningful feedback. The aim of this study was to explore the extent to which the introduction of EPAs via mobile app impacts feedback culture as experienced by anesthesiology residents and attending physicians. Using a constructivist grounded theory approach, the authors interviewed a purposive and theoretical sample of residents (n = 11) and attendings (n = 11) at the Institute of Anaesthesiology, University Hospital of Zurich, where EPAs had recently been implemented. Interviews took place between February and December 2021. Data collection and analysis were conducted iteratively. The authors used open, axial, and selective coding to gain knowledge and understanding on the interplay of EPAs and feedback culture. Participants reflected on a number of changes in their day-to-day experience of feedback culture with the implementation of EPAs. Three main mechanisms were instrumental in this process: lowering the feedback threshold, change in feedback focus, and gamification. Participants felt a lower threshold to feedback seeking and giving and that the frequency of feedback conversations increased and tended to be more focused on a specific topic and shorter, while feedback content tended to focus more on technical skills and more attention was given to average performances. Residents indicated that the app-based approach fostered a game-like motivation to "climb levels," while attendings did not perceive a game-like experience. EPAs may offer a solution to problems of infrequent occurrence of feedback and invite attention to average performances and technical competencies, but may come at the expense of feedback on nontechnical skills. This study suggests that feedback culture and feedback instruments have a mutually interacting influence on each other.

Feedback conversations: First things first?

ObjectiveThis study explores medical students’ perceptions regarding the order in which feedback is given and its impact on how that feedback is received. MethodsMedical students were interviewed regarding their feedback experiences during medical school and preferred order in which to receive feedback. Thematic analysis was applied to interview transcripts to identify salient themes in students’ comments related to feedback order. ResultsTwenty-five students entering their second, third, and fourth years of medical school participated in the study. Students indicated that the order in which feedback was conveyed influenced their receptivity to its content, but varied in their specific order preferences. Most students indicated that they preferred feedback conversations that started with positive observations. Only the most senior students expressed a preference for feedback based on self-assessment. ConclusionFeedback conversations are complicated interactions. Students’ responses to feedback are influenced by a variety of factors, including the order in which feedback is delivered. Practice ImplicationsEducators should recognize that students’ feedback needs may be influenced by a variety of factors, and should aim to tailor feedback and the order of its delivery to the learner.

Meaning making about performance: A comparison of two specialty feedback cultures.

Specialty trainees often struggle to understand how well they are performing, and feedback is commonly seen as a solution to this problem. However, medical education tends to approach feedback as acontextual rather than located in a specialty-specific cultural world. This study therefore compares how specialty trainees in surgery and intensive care medicine (ICM) make meaning about the quality of their performance and the role of feedback conversations in this process. We conducted a qualitative interview study in the constructivist grounded theory tradition. We interviewed 17 trainees from across Australia in 2020, eight from ICM and nine from surgery, and iterated between data collection and analytic discussions. We employed open, focused, axial and theoretical coding. There were significant divergences between specialties. Surgical trainees had more opportunity to work directly with supervisors, and there was a strong link between patient outcome and quality of care, with a focus on performance information about operative skills. ICM was a highly uncertain practice environment, where patient outcome could not be relied upon as a source of performance information; valued performance information was diffuse and included tacit emotional support. These different 'specialty feedback cultures' strongly influenced how trainees orchestrated opportunities for feedback, made meaning of their performance in their day-to-day patient care tasks and 'patched together' experiences and inputs into an evolving sense of overall progress. We identified two types of meaning-making about performance: first, trainees' understanding of an immediate performance in a patient-care task and, second, a 'patched together' sense of overall progress from incomplete performance information. This study suggests approaches to feedback should attend to both, but also take account of the cultural worlds of specialty practice, with their attendant complexities. In particular, feedback conversations could better acknowledge the variable quality of performance information and specialty specific levels of uncertainty.

Application of the R2C2 Model to In-the-Moment Feedback and Coaching.

The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use. A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor-learner dyads. Data were collected during feedback sessions and follow-up interviews between March 2021 and July 2022. The research team familiarized themselves with the data, used a coding template to document examples of the model's application, reviewed the initial framework and revised the coding template, indexed and summarized the data, created a summary document, examined the transcripts for alignment with each model phase, and identified illustrative quotations and overarching themes. Fifteen dyads were recruited from 8 disciplines (11 preceptors were paired with a single resident [n = 9] or a single medical student [n = 2]; 2 preceptors each had 2 residents). All dyads were able to apply the R2C2 phases of building relationships, exploring reactions and reflections, and confirming content. Many struggled with the coaching components, specifically in creating an action plan and follow-up arrangements. Preceptor skill in applying the model, time available for feedback conversations, and the nature of the relationship impacted how the model was applied. The R2C2 model can be adapted to contexts where in-the-moment feedback conversations occur shortly after a clinical encounter. Experiential learning approaches applying the R2C2 model are critical. Skillful application of the model requires that learners and preceptors go beyond confirming an area of change and deliberately engage in coaching and cocreating an action plan.