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Learning culture and feedback: an international study of medical athletes and musicians
Abstract
Objectives: Feedback should facilitate learning, but within medical education it often fails to deliver on its promise. To better understand why feedback is challenging, we explored the unique perspectives of doctors who had also trained extensively in sport or music, aiming to: (i) distinguish the elements of the response to feedback that are determined by the individual learner from those determined by the learning culture, and (ii) understand how these elements interact in order to make recommendations for improving feedback in medical education. Methods: Using a constructivist grounded theory approach, we conducted semi‐structured interviews with 27 doctors or medical students who had high‐level training and competitive or performance experience in sport ( n = 15) or music ( n = 12). Data were analysed iteratively using constant comparison. Key themes were identified and their relationships critically examined to derive a conceptual understanding of feedback and its impact. Results: We identified three essential sources of influence on the meaning that feedback assumed: the individual learner; the characteristics of the feedback, and the learning culture. Individual learner traits, such as motivation and orientation toward feedback, appeared stable across learning contexts. Similarly, certain feedback characteristics, including specificity, credibility and actionability, were valued in sport, music and medicine alike. Learning culture influenced feedback in three ways: (i) by defining expectations for teachers and teacher–learner relationships; (ii) by establishing norms for and expectations of feedback, and (iii) by directing teachers' and learners' attention toward certain dimensions of performance. Learning culture therefore neither creates motivated learners nor defines ‘good feedback’; rather, it creates the conditions and opportunities that allow good feedback to occur and learners to respond. Conclusions: An adequate understanding of feedback requires an integrated approach incorporating both the individual and the learning culture. Our research offers a clear direction for medicine's learning culture: normalise feedback; promote trusting teacher–learner relationships; define clear performance goals, and ensure that the goals of learners and teachers align.
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“Research into learners’ experiences of feedback has highlighted the value placed on feedback that is actionable [38].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
In the citing paper
“Responses to feedback are also shaped by learning culture, and the norms and expectations it creates for feedback [38]”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
In the citing paper
“The feedback exchange is perhaps at its most effective when teachers’ and learners’ goals are aligned [38].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
In the citing paper
“It has also been found in the training of athletes and musicians that critical feedback is exchanged more readily when it is normalized by a learning culture [38, 84].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
In the citing paper
“The crucial role of learning culture in making effective feedback possible, normalizing constructive criticism, and establishing the value of feedback for learning is also missed by an approach focused on individual teachers [38].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
In the citing paper
“Recent literature has begun to challenge this approach, suggesting that the quality and impact of feedback may be compromised when the teacher is assigned this dual role [38, 91, 92].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [38]
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Metadata
- Authors
- Watling, C., Driessen, E., van der Vleuten, C. P. M., & Lingard, L.
- Affiliations
- Western University (CA)
- Maastricht University (NL)
- Department of Educational Development and Research Faculty of Health Medicine, and Life Sciences Maastricht University Maastricht the Netherlands
- Corresponding author
- Watling, Christopher
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2014-06-09
- Volume
- 48
- Issue
- 7
- Pages
- 713-723
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W2073862483
- Cited by
- 162
- References
- 28
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 13 · 2023: 14 · 2022: 12 · 2021: 15 · 2020: 13 · 2019: 21 · 2018: 15 · 2017: 12 · 2016: 13 · 2015: 7 · 2014: 2
- FWCI
- 11.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Social Sciences › Education › Innovations in Medical Education
- Social Sciences › Education › Student Assessment and Feedback
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- feedback, learning culture, sports training, musical training, teacher-student relationship, student motivation, feedback specificity, feedback credibility, performance goals
- MeSH terms
- Attitude of Health Personnel, Education, Medical, Educational Status, Faculty, Medical, Goals, Humans, Interpersonal Relations, Learning, Music, Physicians, Sports, Students, Medical, Organizational Culture, Feedback, Psychological, Qualitative Research
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