Challenges of feedback provision in the workplace: A qualitative study of emergency medicine residents and teachers

Background: Feedback is an effective pedagogical tool in clinical teaching and learning, but is often perceived as unsatisfactory. Little is known about the effect of a busy clinical environment on feedback-giving and -seeking behaviors. This study aims to determine the perceptions and challenges of feedback provision in a busy clinical setting, exemplified by an emergency department (ED). Methods: A qualitative semi-structured interview study design was employed. Thirty-six participants (18 attending physicians, 18 residents) were purposively sampled from three EDs in northern Taiwan between August 2015 and July 2016. Interviews were recorded, transcribed, and analyzed thematically. Results: Three major themes were identified with illustrative quotes: (1) the balance between patient safety and providing feedback, (2) variability in feedback, and (3) influential factors, barriers and enablers. Conclusions: In real practice, clinical duties competed with the impulse to provide feedback. The variety and complexity of feedback extended beyond style and content. Clinical and contextual factors–some of which may be presented as barriers–influenced how, when and whether a teacher or learner decided to give or seek feedback.