Adapting Feedback to Individual Residents: An Examination of Preceptor Challenges and Approaches.

BACKGROUND

Feedback conversations between preceptors and residents usually occur in closed settings. Little is known about how preceptors address the challenges posed by residents with different skill sets, performance levels, and personal contexts.

OBJECTIVE

This study explored the challenges that preceptors experienced and approaches taken in adapting feedback conversations to individual residents.

METHODS

In 2015, 18 preceptors participated in feedback simulations portraying residents with variations in skill, insight, confidence, and distress, followed by debriefing of the feedback conversation with a facilitator. These interactions were recorded, transcribed, and analyzed using thematic and framework analysis.

RESULTS

The preceptors encountered common challenges with feedback conversations, including uncertainty in how to individualize feedback to residents and how to navigate tensions between resident- and preceptor-identified goals. Preceptors questioned their ability to enhance skills for residents, whether they could be directive when residents had , how they could reframe the perceptions of the resident, and whether they should offer support to residents or provide feedback about performance. Preceptors adapted their approach to feedback, drawing on techniques of coaching for residents, directing for residents with , mediation with residents, and mentoring with residents.

CONCLUSIONS

Examining the feedback challenges preceptors encounter and the approaches taken to adapt feedback to individual residents can provide insight into how preceptors meet the challenges of competency-based medical education, in which frequent, focused feedback is essential for residents to achieve educational milestones and entrustable professional activity expectations.