# Judging Oneself and the Feedback: Using a Feedback Literacy Lens to Explore How Learners Experience Professionalism Feedback

## TL;DR

This study explores how medical students and residents experience and respond to professionalism feedback through the lens of feedback literacy.

## Contribution

It introduces feedback literacy as a framework to understand the complexities of professionalism feedback in medical education.

## Key findings

- Learners often viewed professionalism as a character trait, reducing the perceived value of feedback.
- Constructive feedback prompted critical reflection on feedback quality and potential racial bias.
- Emotional responses and lack of agency were common due to how feedback was delivered.

## Abstract

Professionalism is a core competency on which learners should, ideally, receive feedback to improve their performance. Feedback literacy conceptualizes how learners make sense of and use feedback. The contextual and subjective nature of professionalism, along with concerns about professionalism’s potential to encode majority culture norms, add unique complexity to receiving and responding to professionalism feedback. This study used feedback literacy as a framework to explore how diverse learners experience and respond to professionalism feedback.

The authors conducted a multi-center qualitative study with a critical constructivist orientation. Fourth-year medical students and senior residents were interviewed about their experiences with professionalism feedback. Interviews were analyzed using reflexive thematic analysis. Feedback literacy provided an analytic lens for theme development.

Thirty-one medical students and 18 residents were interviewed between 2021 and 2022. Learners saw little value in professionalism feedback when viewing professionalism as a character trait rather than a skill to be improved. Learners who received constructive professionalism feedback critically reflected on the quality of their own professionalism and of the feedback, specifically evaluating the feedback for racial or other bias. Constructive professionalism feedback generated protracted emotional responses, and learners often lacked agency to respond to professionalism feedback due to the method of feedback delivery.

Learners engage with professionalism feedback by spending significant time examining the context of the feedback and searching for evidence of racial or other bias. Understanding how learners experience professionalism feedback is important for fostering strong professionalism feedback literacy for learners and educators.