Fig. 2

Emotional valence and meaning of feedback - code-proximity maps of thematic co-occurrence (individual/group analysis). Feedback that was seen by residents as inaccurate was perceived as unfair and was often disregarded. Residents’ respect for the faculty providing feedback influenced the meaning – a highly respected faculty giving critical feedback could evoke a sense of shame and failure, however this could in parallel be highly motivating if the feedback was actionable. Criticism from faculty who are perceived as rigid, “picky” and unfair, was universally demoralizing and often dismissed. Humor was used often when poor feedback skills (or routine avoidance of feedback) were centered on faculty (“read more”). Sarcasm was common when these poor skills resulted in feedback that was perceived as personally unfair or unjust. These occurrences gave rise to a sense of resentment. In both individual comments and group discussions, face to face feedback was universally perceived as most useful. Residents felt that it necessitated being observed, although these comments were often accompanied by use of humor, suggesting a mild level of discomfort. Discomfort can be psychologically healthy; it indicates motivation to change, which is a necessary component of learning. In individual and group comments, dishonest feedback was met with sarcasm. Group discussion provided compare-and-contrast discussion (increased frequency and wider linking of co-occurrence), with residents expressing humor and sarcasm on behalf of their peers. Analysis performed using MAXQDA 2020. Berlin: VERBI Software, 2019