The problem with feedback

Feedback can be a powerful tool for promoting healthcare safety. However, 'feedback' as a concept tends to embody a number of implicit assumptions arising from behaviourist educational traditions, such as power differentials between feedback providers and receivers, unidirectionality of transmission, and simple notions of ‘error’. Such assumptions can present challenges when designing and implementing feedback initiatives to address complex problems within healthcare such as improving prescribing. Sociocultural conceptions of feedback may be helpful in such cases, so that correspondingly complex solutions can be formulated.

The purpose of this article therefore, is to step back and reconsider the nature and value of the term ‘feedback’ when applied to complex healthcare problems. We consider a number of different conceptions, definitions and understandings of feedback, using our own research on optimising prescribing as a case study and drawing upon our joint reflexive discussions as a team. In doing so, we examine the differences between simple, complicated and complex problems and how these might relate to feedback in medical education. We also explore alternative but related terms to feedback, considering their similarities, differences, and the appropriateness of each when applied to complex activities such as prescribing. Finally, we reflect on the dilemma of whether the medical education community should persevere with using a term which eludes embedded shared conceptualisation, perhaps redefining it to better reflect contemporary usage, or embrace a different term altogether.

By sharing our experiences as a research team grappling with a challenging topic, we hope to engage with the wider community and their insights, in order to benefit our own research and the medical education research field.