Trainee Conceptualisation of Feedback in a South East Asian Setting: An Interpretive Description Study

Background : Feedback is acknowledged as a key component of learning and development of healthcare professionals. A scoping literature review indicated that Culture influenced the seeking and acceptance of feedback by Asian health professional trainees. This study was conducted to further explore the understanding and utilisation of feedback in clinical settings by trainees in an Australian University based in Malaysia. Methods : Interpretive Description was used as the methodological approach. This study involved penultimate year medical trainees from a clinical school based in Johor Bahru, Malaysia. Trainees were recruited by notices in the school and in tutorials, followed by a Zoom meeting to explain in detail before being invited to participate (35 trainees participated in the study). Participants attended two, semi-structured group interviews; 10 entry-group interviews were held mid-2022, 8 exit-group interviews held 3 months later. Participants were invited to submit diaries of feedback experiences between group interviews – 62 diaries submitted by 24 trainees (1 – 5 diaries submitted by each of these trainees). An initial coding framework was developed with input from the research team and iteratively refined through a series of team discussions to identify and consolidate themes. Results : From the trainee perspectives we identified two themes. The first theme is ‘Trainee conceptualisation of feedback’ the dominant conception was ‘feedback as telling’, but comments without advice to improve were not considered feedback). The second theme is ‘Trainee experience of feedback’, encapsulating two aspects: Power distance, hierarchy and humiliation (seen both in the use of embarrassment in teaching and reluctance of trainees to question or provide feedback to supervisors) and collectivism, peer feedback and uncertainty in the context of group and peer feedback. Group feedback was used at bedside teaching and recognised as appropriate yet often considered vague. Peer feedback was encouraged at bedside teaching, but perceptions of peer feedback were varied or ambivalent. Uncertainty about feedback provided caused distress. Conclusions : Feedback was generally understood as telling and error correction. Trainees experienced and observed feedback being given in a harsh manner, but most accepted that approach as valid, as long as they were also given advice about how to improve or correct the errors. Multiple cultures appeared to be at play – the education system culture and workplace culture appeared to interact with ethnic Culture in influencing trainee engagement with feedback.