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"How am I doing?": many problems but few solutions related to feedback delivery in undergraduate psychiatry education.

OBJECTIVE: Giving performance feedback to students in psychiatry requires particular delicacy and skill since a critique of the subjective artistry of the psychiatric interview may be felt more personally than a critique of an objective skill, such as eliciting a reflex or applying a stethoscope to the chest. Thus, one would expect that psychiatrists 1) are adept at giving feedback and 2) have written about the nuances of feedback delivery in psychiatric education. After a curricular needs assessment in our program revealed that feedback delivery was being neglected at all levels of training, a review of the medical education literature was conducted to find explanations for preceptor difficulty with performance feedback delivery in undergraduate psychiatric education. METHOD: A qualitative content-analysis review of the PubMed and OVID literature on feedback delivery and medical education was conducted. RESULTS: Several articles were available on feedback delivery in medical education, but only one of the studies was specific to undergraduate psychiatric education. Several articles offered practical tips to address deficiencies in the feedback process, but there was little to no explanation for the reasons behind the deficiencies. CONCLUSIONS: Reasons for the challenges faced by medical students and teachers during feedback conversations have not been fully explored in the literature. In contrast to other areas of medicine, little has been written specifically about feedback to students in undergraduate psychiatric education. Although there are many resources to assist medical educators with feedback delivery skills, an understanding as to why physicians and students struggle with feedback conversations is needed. Reasons for the apparent disconnect between what should be happening and what is actually happening during feedback conversations with undergraduate psychiatry students need to be understood. The authors hypothesize causes for the problems with feedback delivery in undergraduate psychiatric education.

Achievement↗
PubMed2004

Biased reasoning: adaptive responses to health risk feedback.

The present study examined reactions toward repeated self-relevant feedback. Participants in a community health screening received feedback about their cholesterol level on two separate occasions. Reactions to the first feedback were examined with regard to feedback valence and expectedness. The findings showed that negative feedback was devalued, but only when it was unexpected. Feedback consistency was incorporated into analyses of the second feedback. Again, results showed that negative feedback was not always devalued-only when it was inconsistent with the first feedback. Furthermore, positive feedback was not unconditionally accepted. When receiving unexpected positive feedback of low consistency, recipients were doubtful about its accuracy. Conversely, expected positive feedback was accepted regardless of its consistency. These results suggest that negative or unexpected positive feedbacks evoke greater sensitivity to feedback consistency, indicating elaborate cognitive processing. Theoretical accounts of these findings are discussed.

Adaptation, Psychological↗
PubMed2004

Referral letters to colorectal surgeons: the impact of peer-mediated feedback.

BACKGROUND: General practitioners (GPs) select few patients for specialist investigation. Having selected a patient, the GP writes a referral letter which serves primarily to convey concerns about the patient and offer background information. Referral letters to specialists sometimes provide an inadequate amount of information. The content of referral letters to colorectal surgeons can now be scored based on the views of GPs about the ideal content of referral letters. AIM: To determine if written feedback about the contents of GP referral letters mediated by local peers was acceptable to GPs and how this feedback influenced the content and variety of their referrals. DESIGN: A non-randomised control trial. SETTING: GPs in North Nottinghamshire. METHOD: In a controlled trial, 26 GPs were offered written feedback about the documented contents of their colorectal referral letters over 1 year. The feedback was designed and mediated by two nominated local GPs. The contents of referral letters were measured in the year before and 6 months after feedback. GPs were asked about the style of the feedback. The contents of referral letters and the proportion of patients with organic pathology were compared for the feedback GPs and other local GPs who could be identified as having used the same hospital for their referrals in the period before and after feedback. RESULTS: All GPs declared the method of feedback to be acceptable but raised concerns about their own performance, and some were upset by the experience. None withdrew from the project. There was a difference of 7.1 points (95% confidence interval = 1.9 to 12.2) in the content scores between the feedback group and the controls after adjusting for baseline differences between the groups. Of the GPs who referred to the same hospital before and after feedback, the feedback GPs referred more patients with organic pathology than other local colleagues. CONCLUSIONS: GPs welcome feedback about the details appearing on their referral letters, although peer comparisons may not always lead to changes in practice. However, in some cases feedback improves the content of GP referral letters and may also impact on the type of patients referred for investigation by specialists.

Attitude of Health Personnel↗
PubMed2005

Effects of correct and transformed visual feedback on rhythmic visuo-motor tracking: tracking performance and visual search behavior.

The effects of correct and transformed visual feedback on rhythmic unimanual visuo-motor tracking were examined, focusing on tracking performance (accuracy and stability) and visual search behavior. Twelve participants (reduced to 9 in the analyses) manually tracked an oscillating visual target signal in phase (by moving the hand in the same direction as the target signal) and in antiphase (by moving the hand in the opposite direction), while the frequency of the target signal was gradually increased to probe pattern stability. Besides a control condition without feedback, correct feedback (representing the actual hand movement) or mirrored feedback (representing the hand movement transformed by 180 degrees) were provided during tracking, resulting in either in-phase or antiphase visual motion of the target and feedback signal, depending on the tracking mode performed. The quality (accuracy and stability) of in-phase tracking was hardly affected by the two forms of feedback, whereas antiphase tracking clearly benefited from mirrored feedback but not from correct feedback. This finding extends previous results indicating that the performance of visuo-motor coordination tasks is aided by visual feedback manipulations resulting in coherently grouped (i.e., in-phase) visual motion structures. Further insights into visuo-motor tracking with and without feedback were garnered from the visual search patterns accompanying task performance. Smooth pursuit eye movements only occurred at lower oscillation frequencies and prevailed during in-phase tracking and when target and feedback signal moved in phase. At higher frequencies, point-of-gaze was fixated at a location that depended on the feedback provided and the resulting visual motion structures. During in-phase tracking the mirrored feedback was ignored, which explains why performance was not affected in this condition. Point-of-gaze fixations at one of the end-points were accompanied by reduced motor variability at this location, reflecting a form of visuo-motor anchoring that may support the pick up of discrete information as well as the control of hand movements to a desired location.

Adult↗
PubMed2005

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness.

PURPOSE: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback. METHODS: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. RESULTS: Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback. CONCLUSION: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlight questions for further study.

Attitude of Health Personnel↗
PubMed2003

Dynamics of deterministic and stochastic paired excitatory-inhibitory delayed feedback.

We examine the effects of paired delayed excitatory and inhibitory feedback on a single integrate-and-fire neuron with reversal potentials embedded within a feedback network. These effects are studied using bifurcation theory and numerical analysis. The feedback occurs through modulation of the excitatory and inhibitory conductances by the previous firing history of the neuron; as a consequence, the feedback also modifies the membrane time constant. Such paired feedback is ubiquitous in the nervous system. We assume that the feedback dynamics are slower than the membrane time constant, which leads to a rate model formulation. Our article provides an extensive analysis of the possible dynamical behaviors of such simple yet realistic neural loops as a function of the balance between positive and negative feedback, with and without noise, and offers insight into the potential behaviors such loops can exhibit in response to time-varying external inputs. With excitatory feedback, the system can be quiescent, can be periodically firing, or can exhibit bistability between these two states. With inhibitory feedback, quiescence, oscillatory firing rates, and bistability between constant and oscillatory firing-rate solutions are possible. The general case of paired feedback exhibits a blend of the behaviors seen in the extreme cases and can produce chaotic firing. We further derive a condition for a dynamically balanced paired feedback in which there is neither bistability nor oscillations. We also show how a biophysically plausible smoothing of the firing function by noise can modify the existence and stability of fixed points and oscillations of the system. We take advantage in our mathematical analysis of the existence of an invariant manifold, which reduces the dimensionality of the dynamics, and prove the stability of this manifold. The novel computational challenges involved in analyzing such dynamics with and without noise are also described. Our results demonstrate that a paired delayed feedback loop can act as a sophisticated computational unit, capable of switching between a variety of behaviors depending on the input current, the relative strengths and asymmetry of the two parallel feedback pathways, and the delay distributions and noise level.

Action Potentials↗
PubMed2003

Neuropsychological impairment in patients with major depressive disorder: the effects of feedback on task performance.

BACKGROUND: Recent evidence suggests that an abnormal response to performance feedback may contribute to the wide-ranging neuropsychological deficits typically associated with depressive illness. The present research sought to determine whether the inability of depressed patients to utilize performance feedback advantageously is equally true for accurate and misleading feedback. METHOD: Patients with major depression and matched controls completed: (1) a visual discrimination and reversal task that featured intermittent and misleading negative feedback; and (2) feedback and no-feedback versions of a computerised test of spatial working memory. In the feedback version, negative feedback was accurate, highly informative, and could be used as a mnemonic aid. RESULTS: On the Probability Reversal task, depressed patients were impaired in their ability to maintain response set in the face of misleading negative feedback as shown by their increased tendency to switch responding to the 'incorrect' stimulus following negative reinforcement, relative to that of controls. Patients' ability to acquire and reverse the necessary visual discrimination was unimpaired. On the Spatial Working Memory task, depressed patients made significantly more between-search errors than controls on the most difficult trials, but their ability to use negative feedback to facilitate performance remained intact. CONCLUSIONS: The present results suggest that feedback can have different effects in different contexts. Misleading, negative feedback appears to disrupt the performance of depressed patients, whereas negative but accurate feedback does not. These findings are considered in the context of recent studies on reinforcement systems and their associated neurobiological substrates.

Adult↗
PubMed2001

Augmented feedback reduces jump landing forces.

STUDY DESIGN: Randomized, experimental design using a 1-way ANCOVA to determine the influence of various forms of feedback on jump landing forces. OBJECTIVE: To investigate the effects of augmented feedback versus sensory feedback on the reduction of jump landing forces. BACKGROUND: Several investigators have reported an increased risk of lower extremity injury associated with landing from a jump. METHODS AND MEASURES: Nonimpaired college students (N=63) were randomly assigned to 1 of 4 feedback groups. Subjects were instructed to perform maximal vertical jumps onto a force plate for 3 testing sessions (baseline, 2-minute post-test, and 1-week post-test). Three feedback groups (augmented, sensory, and control I) were tested during all 3 testing sessions, while a fourth feedback group (control II) was evaluated at only 2 sessions (baseline and 1-week post-test). Subjects in the augmented feedback condition were provided information via video and verbal analysis of how to land softer. Subjects in the sensory feedback condition were asked to use the experience of their baseline jumps to document how they could land softer. Subjects in each of the control groups were not provided any extraneous feedback. Peak vertical ground reaction force data were collected for analysis. RESULTS: The subjects in the augmented feedback group significantly reduced their peak vertical ground reaction force in both post-test conditions (2-minute post-test reduction, 0.85+/-0.62; 1-week post-test reduction, 0.74+/-0.58) as compared to the sensory, control I, and control II feedback groups. CONCLUSIONS: High impact landing forces may be reduced by the implementation of augmented feedback information instructing individuals about how to land properly. The reduction of jump landing forces with the use of augmented feedback may prove beneficial in the creation of instructional landing programs.

Adaptation, Physiological↗
PubMed2001

Effect of feedback on obstetrics and gynecology residents' teaching performance and attitudes.

OBJECTIVE: To evaluate obstetrics and gynecology residents' teaching performance, perception of the importance of teaching and satisfaction with their evaluations after the institution of an oral or written medical student feedback and award system. STUDY DESIGN: Residents at a single, university-based obstetrics and gynecology program were assigned to receive either oral, written or no medical student feedback on their teaching skills in a prospective, randomized, controlled trial. Students rated resident performance in seven teaching categories. Residents' scores per six-week block were evaluated for one year. Questionnaires addressing resident attitudes toward feedback were collected at baseline and at 6 and 12 months. All residents then received written feedback and public awards for high scores for an additional year. RESULTS: After 12 months of feedback there were trends toward improvement in several of the teaching categories and overall evaluations. None of the controls, 29% of residents receiving oral feedback and 50% of residents receiving written feedback rated teaching as more important than before. None of the controls, 57% of those receiving oral feedback (P = NS) and 88% of those receiving written feedback (P = .009), for a total of 73% of residents receiving any feedback (P = .001), thought that the amount of feedback was adequate at 12 months. Follow-up of 15 residents after one year of written feedback with an award for high evaluations showed that 60% improved their overall scores. The mean overall group score improved. CONCLUSION: A feedback and award system can lead to improved resident teaching performance as well as enhanced perception of residents' role as teachers and greater resident satisfaction.

Attitude of Health Personnel↗
PubMed1976

Effects of positive and negative feedback on behavior control in hyperactive and normal boys.

The hypothesis that hyperactive boys have relatively less response to negative feedback than to positive feedback was studied. Sixteen hyperactive boys and 16 controls were compared on two tasks under different feedback conditions. Feedback conditions were no feedback, positive feedback, and negative feedback. Tasks were symbol encoding and correcting spelling words. Hyperactives and controls were compared in amount of time on-task and amount of work correctly completed. Hyperactives were on-task significantly more under conditions of negative feedback than under positive feedback, but negative feedback significantly increased errors on the spelling correction task. Controls were equally responsive to positive, negative, or no feedback. Hyperactives accomplished significantly less than controls on the coding task, but performed as well as controls on the spelling correction task, which was administered to each boy at his own level of spelling ability. The results imply that while consistent negative feedback can reduce off-task behavior for hyperactives, it can also decrease the accuracy of the work they are doing.

Behavior Therapy↗
PubMed2006

Orientation feedback during simulated simple translation tests has little clinical significance on the magnitude and precision of glenohumeral joint translations.

The repeatability of shoulder instability clinical examinations has been reported to be poor, producing a large range of translations. The objective of this study was to determine the effect of providing the clinician with joint orientation feedback on the magnitude and precision of glenohumeral joint kinematics. A 6-degree of freedom magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula (n=8 cadaveric shoulders). The joints were preconditioned with simple loading tests five times. At 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, a clinician then applied an anterior and posterior load to the humerus until a manual maximum simulating a simple translation test (STT) was achieved at 0, 30, and 60 degrees of external rotation with and without angular orientation feedback of the humerus with respect to the scapula. The precision for the external rotation was within 4.3 degrees for the feedback group and 17.5 degrees for the no feedback group over all external rotations. For achieving the target external rotation of 30 degrees , there was a significant difference in precision between the feedback and no feedback groups (p<0.05). The magnitudes of the anterior translations were 18.2+/-5.3, 15.5+/-5.1, and 9.9+/-5.5 mm for the feedback group and 19.3+/-6.6, 17.5+/-4.9, and 11.5+/-5.3 mm for the no feedback group, at 0, 30, and 60 degrees of external rotation, respectively. There was a significant difference in the precision of anterior translation at 30 and 60 degrees of external rotation for 4 of 8 specimens (p<0.05). Significant differences in the precision of the posterior translation was only detected at 0 degrees of external rotation for 3 of 8 specimens (p<0.05). Based on the data obtained, providing orientation feedback to a clinician performing a simulated STT results in increased precision for not only the target external rotations but also the resulting glenohumeral translations. While providing feedback may be a necessary step to achieving precise results for experimental studies, the magnitudes of translations in the anterior and posterior directions were relatively similar for the feedback and no feedback states indicating little benefit for clinical examinations.

Biomechanical Phenomena↗
PubMed2003

The use of visual feedback and on-line target information in catching and grasping.

Although visual feedback (i.e. seeing our hand while we move it) improves the accuracy and efficiency of grasping movements, these positive effects of visual feedback are not consistently found for catching. It was the aim of our study to compare the efficiency of the use of visual feedback in grasping and catching and to explore possible reasons why visual feedback effects have been found less consistently in catching than in grasping. The first reason might be technical. Less sensitive measurement methods have been used in catching; this might explain why some catching studies did not find visual feedback effects. This problem was avoided in our study by using the same methods for both the catching and the grasping task. The effects of visual feedback were examined under standard conditions and under conditions where subjects wore prismatic glasses. Nevertheless, visual feedback effects were obtained for grasping but not for catching movements. This confirms that the difference in the use of visual feedback is real and not due to technical differences between grasping and catching studies. The second reason relates to the different temporal demands of grasping and catching. During a catching task, subjects have less time to respond, and therefore might not have sufficient time to use visual feedback. We tested this explanation with a task that required subjects to reach for a stationary object (i.e. grasping) as quickly as they had for the moving object in the catching task. However, even in this time-constrained grasping task, significant visual feedback effects were found, suggesting that time constraints do not explain the lack of visual feedback effects in catching. In our last explanation, we suggest that possibly the mode of motor control is different for catching and grasping, more particularly while grasping allows for on-line corrections, such corrections might not be possible for catching movements. We tested this explanation with a catching task that contained perturbation trials. During those perturbation trials, the target trajectory was shifted, after the subject had already started to move. We found that subjects responded to the target shifts with an appropriate shift of their catching response. This shows that on-line corrections are possible in the case of catching movements. We conclude that neither differences in the temporal demands nor in the capacity to make on-line modifications explain why visual feedback is used less effectively in the catching than in the grasping task.

Adult↗
PubMed1997

The role of feedback in learning a vernier discrimination task.

We compare improvement through training in vernier acuity under different feedback conditions in order to clarify the role of feedback during learning of a perceptual task and to test different (neural network) models of perceptual learning. Improvement of performance is measured in 49 observers under feedback, no feedback, uncorrelated feedback, partial feedback, and block feedback conditions. Correct feedback conditions yield a larger improvement of performance than manipulated and no feedback conditions. Providing feedback that is uncorrelated to the observers' responses prevents learning, while the effect of block feedback does not differ significantly from complete feedback. Our results cannot be explained by learning rules that depend exclusively on an external teacher or by models that propose learning in an exposure-dependent way with unsupervised learning rules but without top-down influences.

Discrimination, Psychological↗
PubMed2002

The effects of age and feedback on isometric knee extensor force control abilities.

OBJECTIVE: To investigate the effects of age and feedback on submaximal isometric force control abilities in the knee extensors. DESIGN: Analysis of a force control task in a quasi-experimental design. BACKGROUND: The ability to control submaximal strength is important to accomplish activities of daily living. The purpose of this study was to investigate the effects of age, feedback, and force level on force control ability in knee extension, which is often used to accomplish daily activities. METHODS: The performance of an isometric force control task was measured in young (mean age 26, SD 2.7 yrs) and older (mean age 72, SD 2.0 yrs) adult healthy male participants. Each participant maintained a steady force in knee extension at two levels of force (20% and 60% MVC) with and without visual bandwidth feedback. Age, force level, and feedback effects were examined on the dependent variables of force variability, bias, and time in bandwidth. RESULTS: Both groups were fairly accurate at accomplishing the task, particularly at the lower force level. The higher force was harder to control, particularly when feedback was absent. The absence of feedback did not affect variability during force control. Older adults performed with less variability and a higher safety margin. Both groups performed better in time spent in bandwidth and safety margin with visual feedback, compared to the no-feedback condition. CONCLUSIONS: Healthy older and younger adults performed quite similarly regardless of feedback being provided or not. The intermittent feedback condition may have been more closely aligned with a no feedback condition rather than a continuous feedback condition. RELEVANCE: Clinical evaluation of submaximal force control ability may be useful for delineating impairments in motor skill and measuring outcomes of intervention programs. To be useful in the clinic, force control assessments must be both sensitive and specific to underlying impairments. The current study investigated the normal range of force control variability to allow the detection of true impairments.

Adult↗
PubMed2001

360 degree feedback: accuracy, reactions, and perceptions of usefulness.

This study examined how 360 degree feedback ratings and self-other rating discrepancies related to reactions to feedback, perceptions of feedback accuracy, perceived usefulness of the feedback, and recipients' receptivity to development. The results indicated that less favorable ratings were related to beliefs that feedback was less accurate and to negative reactions. Negative reactions and perceptions that feedback was less accurate were related to beliefs that the feedback was less useful. Those who found feedback less useful were perceived by a facilitator as less development-focused. Goal orientation did not moderate the relationship between ratings and perceptions of accuracy or reactions to feedback. Goal orientation was related to perceptions of usefulness of the process several weeks after receipt of feedback. The results question widely held assumptions about 360 degree feedback that negative and discrepant feedback motivates positive change.

Adult↗
PubMed1996

Learning a partial-weight-bearing skill: effectiveness of two forms of feedback.

BACKGROUND AND PURPOSE: Partial weight bearing (PWB) is a skill commonly taught by physical therapists. This study compared the effects of practice with either augmented feedback provided during the task (concurrent feedback) or augmented feedback provided after the task (postresponse feedback) for the learning of PWB with crutches. SUBJECTS: Sixty young adults without known impairment of the neuromusculoskeletal system volunteered for the study. METHODS: Subjects practiced supporting 30% of body weight while stepping onto a floor scale. Augmented feedback was provided during each trial for the concurrent feedback group and either following each trial or after every five trials for the postresponse feedback groups. Subjects returned 2 days later for a no-feedback retention test. RESULTS: During practice, the concurrent feedback group was more accurate and consistent than either of the postresponse feedback groups. During retention, however, the postresponse feedback groups were the most accurate; all groups were equally consistent during retention. CONCLUSION AND DISCUSSION: These results suggest that practice with concurrent feedback is beneficial for the immediate performance but not for the learning of this sensorimotor skill.

Adult↗
PubMed2004

Medical students' perceptions of feedback in a busy ambulatory setting: a descriptive study using a clinical encounter card.

BACKGROUND: Residents and medical students have expressed repeated concerns over the years about the inadequate amounts and quality of feedback in the clinical setting. Despite innovative ways to teach the skill of giving feedback, the problem has not been fixed. METHODS: In this study, the author introduced the clinical encounter card to the ambulatory setting for faculty to use as a cue to provide feedback to students. At the end of the 4-week rotation, students anonymously reported on the amount, frequency, and quality of feedback they received. RESULTS: Students reported that the learning climate for giving/receiving feedback was very good to excellent. They rated the quality and amount of feedback they received from faculty as high on the Likert scale and the frequency just above the mean. Most of the feedback was directed toward knowledge and skills, and there were few reports of demeaning behavior. Feedback was timely, and students reported using the feedback to improve their performance. The clinical encounter card improved feedback to students in a busy ambulatory setting. Whereas the author did not monitor how often the clinical encounter card was used, there were ample cards on each student to provide mid-rotation feedback and summative evaluations. The students rated the process as the best of any clerkship rotation. CONCLUSIONS: The clinical encounter card is an effective tool to enhance feedback in a busy pediatric ambulatory setting. It is not known if these results are generalizable, but readers are encouraged to repeat the study in other settings.

Feedback↗
PubMed2006

Physician characteristics associated with proficiency in feedback skills.

BACKGROUND: Providing and eliciting high-quality feedback is valuable in medical education. Medical learners' attainment of clinical competence and professional growth can be facilitated by reliable feedback. This study's primary objective was to identify characteristics that are associated with physician teachers' proficiency with feedback. METHODS: A cohort of 363 physicians, who were either past participants of the Johns Hopkins Faculty Development Program or members of a comparison group, were surveyed by mail in July 2002. Survey questions focused on personal characteristics, professional characteristics, teaching activities, self-assessed teaching proficiencies and behaviors, and scholarly activity. The feedback scale, a composite feedback variable, was developed using factor analysis. Logistic regression models were then used to determine which faculty characteristics were independently associated with scoring highly on a dichotomized version of the feedback scale. RESULTS: Two hundred and ninety-nine physicians responded (82%) of whom 262 (88%) had taught medical learners in the prior 12 months. Factor analysis revealed that the 7 questions from the survey addressing feedback clustered together to form the "feedback scale" (Cronbach's alpha: 0.76). Six items, representing discrete faculty responses to survey questions, were independently associated with high feedback scores: (i) frequently attempting to detect and discuss the emotional responses of learners (odds ratio [OR]=4.6, 95% confidence interval [CI] 2.2 to 9.6), (ii) proficiency in handling conflict (OR=3.7, 95% CI 1.5 to 9.3), (iii) frequently asking learners what they desire from the teaching interaction (OR=3.5, 95% CI 1.7 to 7.2), (iv) having written down or reviewed professional goals in the prior year (OR=3.2, 95% CI 1.6 to 6.4), (v) frequently working with learners to establish mutually agreed upon goals, objectives, and ground rules (OR=2.2, 95% CI 1.1 to 4.7), and (vi) frequently letting learners figure things out themselves, even if they struggle (OR=2.1, 95% CI 1.1 to 3.9). CONCLUSIONS: Beyond providing training in specific feedback skills, programs that want to improve feedback performance among their faculty may wish to promote the teaching behaviors and proficiencies that are associated with high feedback scores identified in this study.

Adult↗