Questions about feedback

Answer to "How can health professions educators work towards a learning culture that values feedback?"

To answer this question, it is worth briefly looking at Sociocultural theory, a psychological theory that proposes that humans learn largely through social interactions. A related concept is that of ‘communities of practice’, which describes transformation of individuals through participation in shared activities within a community, and learning through interactions and collaborations. The following activities allow effective learning and transformation:

  • Learners take on increasing responsibilities in joint activities

  • Institutions adopt a developmental approach in identifying learner abilities- i.e. establishing clear expectations of performance for learners at different levels of training and communicating these to teachers and learners

  • Learners and teachers together identify gaps in current performance versus expected performance and co-develop learning plans

  • Faculty are trained to balance supervision and autonomy- appropriate to level and abilities of learners, guiding them towards independent practice


The feedback encounter is a complex social interaction, influenced by many cultural factors such as the stress of the work environment, time pressures, emotions during the conversation especially if the information is viewed as criticism, interpersonal tensions and the context.


Teachers hesitate to provide constructive feedback to avoid damaging their working relationships with learners and adversely impacting learner self-esteem. A learning culture that values feedback  could be viewed as an institution’s overt expectations for ongoing exchange of non-threatening, behaviour-focussed feedback and establishment of a learning environment that facilitates feedback conversations and opportunities for performance improvement. Framing feedback as “coaching for improvement” can foster such a learning culture. Strategies to promote a conducive feedback culture might include:

  • Facilitation of longitudinal relationships between faculty and learners

  • Provision of time and space for feedback conversations

  • Expectation that feedback would be a dynamic two-way exchange

  • Understanding that professionals at all levels will possess strengths and multiple areas for improvement; role modelling accepting and acting on feedback and coaching

  • Faculty development in coaching strategies

  • Encouraging feedback providers to focus on impact and behaviour change

  • Training in facilitating self-assessment and self-reflection


It is important for institutions to establish a learning culture that is conducive to growth enhancing feedback through: explicit guidelines for ongoing formative feedback; a learning environment that normalises strengths as well as areas for improvement among learners and teachers; longitudinal and trusting relationships between learners and teachers; direct observation of performance; feedback seeking among teachers and learners; and training in goal-directed and actionable feedback conversations.




Ramani, S. M., Konings, K. D., Mann, K. V., Pisarski, E. E., et al. (2018) ‘About Politeness, Face, and Feedback:  Exploring Resident and Faculty Perceptions of How Institutional Feedback Culture Influences Feedback Practices’, Academic Medicine, 93(9), pp. 1348–1358.

Ramani, S., Post, S. E., Könings, K., Mann, K., et al. (2017) ‘“It’s Just Not the Culture”: A Qualitative Study Exploring Residents’ Perceptions of the Impact of Institutional Culture on Feedback’, Teaching and Learning in Medicine, 29(2), pp. 153–161.

Watling, C., Driessen, E., van der Vleuten, C. P. M., Vanstone, M., et al. (2013) ‘Beyond individualism: professional culture and its influence on feedback’, Medical Education, 47(6), pp. 585–594.