• Subha Ramani, Karen D Könings, Karen V Mann, Emily E Pisarski, and van der Vleuten Cees P M CPM.
• S. Ramani is director, Scholars in Medical Education Pathway, Internal Medicine Residency Program, Brigham and Women's Hospital, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-8360-4031. K.D. Könings is associate professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0003-0063-8218. K.V. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E.E. Pisarski is research associate, Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. C.P.M. van der Vleuten is director, School of Health Professions Education, and professor of education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0001-6802-3119.
• Acad Med. 2018 Sep 1; 93 (9): 1348-1358.

PurposeTo explore resident and faculty perspectives on what constitutes feedback culture, their perceptions of how institutional feedback culture (including politeness concepts) might influence the quality and impact of feedback, feedback seeking, receptivity, and readiness to engage in bidirectional feedback.MethodUsing a constructivist grounded theory approach, five focus group discussions with internal medicine residents, three focus group discussions with general medicine faculty, and eight individual interviews with subspecialist faculty were conducted at Brigham and Women's Hospital between April and December 2016. Discussions and interviews were audiotaped and transcribed verbatim; concurrent data collection and analysis were performed using the constant comparative approach. Analysis was considered through the lens of politeness theory and organizational culture.ResultsTwenty-nine residents and twenty-two general medicine faculty participated in focus group discussions, and eight subspecialty faculty participated in interviews. The institutional feedback culture was described by participants as (1) a culture of politeness, in which language potentially damaging to residents' self-esteem was discouraged; and (2) a culture of excellence, in which the institution's outstanding reputation and pedigree of trainees inhibited constructive feedback. Three key themes situated within this broader cultural context were discovered: normalizing constructive feedback to promote a culture of growth, overcoming the mental block to feedback seeking, and hierarchical culture impeding bidirectional feedback.ConclusionsAn institutional feedback culture of excellence and politeness may impede honest, meaningful feedback and may impact feedback seeking, receptivity, and bidirectional feedback exchanges. It is essential to understand the institutional feedback culture before it can be successfully changed.

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