Feedback, learning and becoming: Narratives of feedback in complex performance challenges.

INTRODUCTION: Becoming a general practitioner (or family medicine specialist) is challenging, as trainees learn to manage complex and ambiguous situations. Feedback is a key component of this learning. Although research has tended to focus on feedback's momentary processes and impacts, there is value in seeking to understand the work it does over time and how trainees position themselves across multiple feedback encounters. We ask: how do newly qualified GPs narrate themselves and their experiences with complex performance challenges? Within these narratives, what is the role of feedback? METHODS: The research adopts a holistic and sequential narrative analysis approach, with in-depth narrative interviews of 16 general practice trainees who had just completed their training requirements. The analysis involved restorying the participant narratives chronologically. Each narrative formed a unit of analysis where narrative commonalities across plots, characters, emotions and the role of feedback were interpreted. RESULTS: Four plotlines within GP trainees' stories of complex performance challenges were identified: Journeyperson, Hero's Quest, Solo Journeyer and Endless Struggle. Trainees, supervisors and feedback are positioned differently within these plotlines. Narratives were saturated with emotions. DISCUSSION: The plotlines bring together an alternative way of understanding how feedback, learning and becoming are woven together. They illustrate how multiple interactions with patients, supervisors, peers and systems thread together into an overall trajectory. How a trainee positions themselves as protagonists and who they characterise as their antagonists can help direct the focus of supervisors' feedback conversations.

Learning to recognise what good practice looks like: how general practice trainees develop evaluative judgement.

The nature of healthcare means doctors must continually calibrate the quality of their work within constantly changing standards of practice. As trainees move into working as fully qualified professionals, they can struggle to know how well they are practising in the absence of formal oversight. They therefore need to build their evaluative judgement: their capability to interpret cues and messages from the clinical environment, allowing them to judge quality of practice. This paper explores how Australian general practice (GP) trainees develop their evaluative judgement. We interviewed 16 GPs, who had recently completed certification requirements, asking them how they managed complex learning challenges across their training trajectory. A thematic analysis was sensitised by conceptualisations of evaluative judgement and feedback for future practice. Findings are reported via three themes: sources of performance relevant information; sense-making about progress within complex learning challenges; and changing practice as evaluative judgement develops. Trainees actively sought to understand what quality practice looked like within complex and ambiguous circumstances but often found it difficult to calibrate their performance. While reflective practice was key to developing evaluative judgment, feedback conversations could provide significant opportunities for trainees and supervisors to co-construct meaning. A 'feedback community' was available for frequent instances where supervisors were absent or not regarded as entirely credible, although feedback conversations in themselves did not necessarily assist trainees to develop evaluative judgement. There is room for a more active role for supervisors in assisting trainees to consider how to independently make sense of learning cues.