Developing essential professional skills: a framework for teaching and learning about feedback

We suggest that a single "teaching the skill of feedback" session provides superficial and ineffective learning in a medical culture that often uses feedback skills poorly or discourages feedback. Our experience suggests that both the skill and the underlying attitude informing its application must be addressed, and is best done so longitudinally and reiteratively using different forms of feedback delivery. These feedback learning opportunities include written and oral, peer to peer and cross-hierarchy, public and private, thereby addressing different cognitive processes and attitudinal difficulties.We conclude by asking whether it is possible to build a consensus approach to a framework for teaching and learning feedback skills?Notwithstanding many recent changes to the medical curriculum, medical teaching retains a strong apprentice-based element, in which experienced senior doctors pass on their knowledge and skills to students and juniors. The requirements of the profession demand both extensive acquisition of knowledge and a high level of specialist skill development. Multiple academic and qualification hurdles have to be surmounted and there is a highly structured promotion system. This hierarchy of skills and knowledge has consequences for the profession's ethos. First, juniors inevitably know and can do less than seniors. If ineffective or inadequate negative or positive feedback is given, juniors may either develop "false confidence" or become demoralised and fearful of making mistakes. This fear can easily lead to a culture of criticism or blame and so to defensiveness, closing down the junior's openness to learning. Either outcome can be ultimately dispiriting, especially in a highly stressful profession [1,2]. Second, the hierarchical nature of the profession discourages feedback from junior to senior doctors making for a uni-directional "them and us" educational and professional experience. The consequences for the profession of this difficulty in effec