The Characteristics, Supports and Barriers of Feedback Provided to Medical Students: A Mixed Methods Study in a Tertiary Care Medical Institute in Northeastern Thailand

Abstract

Background: The learning culture influences how feedback is provided and whether learners are able to reflect and act on feedback. Thais value cooperation to preserve a natural, hierarchal and social order. Objectives: To explore feedback provided from faculty to medical students as well as perspectives, enabling factors, barriers and feedback-seeking behaviors. Methods: This is a mixed methods study; clinical faculty and medical students (years 4-6) were invited to participate in focus group discussions and individual interviews. Baseline characteristics, frequency of feedback, attitude towards feedback and goal-orientation was collected and used to triangulate qualitative data. Results: Thirty faculty participated in 1 focus group (n=4) and 27 individual in-depth-interviews. Twenty-two medical students participated in 4 focus groups. Students reported receiving feedback in total at least once or twice a month. Faculty overestimated students’ negative response to feedback and underestimate students' positive response to feedback. Four major themes were identified: (1) Feedback is the responsibility of faculty; (2) Most feedback is appreciated and accepted if there are action plans for performance improvement; (3) Feedback is initiated by deficit identification and aimed to help students improve; (4) Hierarchy and “kreng jai” perpetuate one-way and top-down feedback conversations. Conclusion: The existing cultures need to be addressed to appropriately develop programs to foster feedback for student’s learning enhancement.