# How Learning Culture Influences the Survivability of an Online Feedback Tool

## TL;DR

This study examines how the learning culture affects the long-term success of an online feedback tool used by clinical faculty.

## Contribution

The study introduces a socio-cultural perspective to understand the survivability of online feedback tools in clinical education.

## Key findings

- A lack of support system increased the burden on clinical teachers.
- Misunderstandings about written feedback and low psychological safety reduced tool adoption.
- Lack of appreciation for feedback loops decreased the tool's long-term viability.

## Abstract

Many online tools and innovations exist to support feedback, but their survivability has not been well-studied. This study explores the influence of learning culture on the adoption, utilization and long-term impact of an online written feedback tool among faculty. The study aims to inform strategies for effective implementation of such tools and guide faculty development within the clinical learning environment.

Utilizing constructivist grounded theory, we conducted semi-structured interviews among ten clinical faculty with supervisory roles and experience in giving medical trainees feedback via an online feedback tool. Using an iterative analytic approach, we identified key propositions to derive an in-depth understanding between learning culture (LC) and the “survivability” of the online feedback tool.

Several socio-cultural factors within the LC have affected the survivability of the feedback tool beyond its development and implementation. Firstly, the lack of a support system exacerbated the burden of clinical teachers. Next, the misapprehension about written feedback and low psychological safety undermined the tool adoption. Lastly, the lack of appreciation towards the importance of a strong feedback loop further reduced the tool’s survivability.

The development and implementation of online tools in health professions education should take into consideration factors influencing the survivability of the tool. The exploration from a socio-cultural perspective has provided insights to ensure that future online feedback tools and interventions actually survive the test of time and the complexities embedded in the clinical learning environment.