A group concept mapping approach to understanding barriers to and possible solutions for quality feedback exchange on the surgery clerkship

Medical students require assessment and actionable feedback to develop clinical competency. However, feedback is of inconsistent quality and is frequently ineffective. To further our understanding about faculty and students’ perceptions about challenges to feedback and improve the feedback experience on the surgery clerkship, we aimed to use Group Concept Mapping (GCM), a participatory research methodology, to 1) identify barriers to exchanging feedback on the surgery clerkship and 2) examine how an institutional quality initiative to improve feedback (the Flash Feedback tool) might address the identified barriers.

We prospectively enrolled study participants from 10/2022 to 03/2023. Third-year medical students completing their surgery clerkship during the 2022–2023 academic year and department of surgery faculty at a single institution were eligible for inclusion. GCM participants utilized an asynchronous web-based platform to brainstorm barriers to feedback. Participants then individually sorted the brainstormed ideas into categories based on perceived relatedness. Sorted items were analyzed to generate a two-dimensional graphical representation of associations between ideas and concepts. GCM was also used to evaluate faculty and student perceptions about the effectiveness of the Flash Feedback tool implemented during the same academic year.

20 participants identified 44 unique barriers to providing/receiving feedback. Hierarchical cluster analysis resulted in a four-cluster solution composed of the following domains: 1) lack of longitudinal exposure, 2) time constraints, 3) perceived interpersonal challenges, and 4) lack of objectivity/standardization. Both students and faculty rated the Flash Feedback tool favorably in addressing these barriers.

The barriers identified by the students and faculty in our GCM study represent a cohesive knowledge structure with which to conceptualize challenges to exchanging feedback. Standardized, immediate post-encounter web-based applications such as our Flash Feedback tool may be especially helpful to address issues with subjectivity, non-specific feedback, and perceived interpersonal challenges that impede trust between educator and learner.