The value of residents’ feedback becomes clear when a programme can show what changed because of it. That requires a route from a reported difficulty to an educational response, with someone responsible for following it through.

A qualitative study in Sudan involved 48 internal medicine residents in six focus groups across six teaching hospitals. Participants valued the programme’s structure and clinical exposure, while requesting earlier, continuing research support and clearer assessment feedback. They described delayed logbook completion limiting opportunities for feedback. Purposive sampling in one specialty limits the generalisability of these accounts.

These accounts invite practical examination of the support available throughout training. A resident could be asked to describe the last time they sought help with a project or received feedback after an assessment. Following that account step by step can identify where a process becomes difficult: finding the right person, securing a meeting, understanding the advice or arranging another opportunity to practise.

Research support can be organised around the work residents need to complete. A programme reported at Baystate Medical Center combined mentoring, protected research time and practical assistance, including statistical support. This offers an example of connecting teaching with the conditions needed to undertake a project.

For a locally designed approach, consider a resident interested in delays in completing discharge summaries. An initial meeting could narrow the question and assess feasibility. The next could review a short proposal covering the study population, measurements, analysis and required approvals. A shared schedule could identify the next task, the person providing help and the date for review. This is an illustrative teaching sequence whose scope would need to match local capacity.

Feedback also needs a usable structure. The R2C2 model organises a conversation around building a relationship, exploring the learner’s reactions, examining the assessment content and coaching towards change. Its development included qualitative feasibility testing with physicians.

Applied to a residency review, a supervisor could begin by asking how the resident understood the assessment. They could then examine a specific example together, agree on the skill needing attention and choose a realistic next step. If the concern involves explaining clinical decisions, the resident might practise presenting the reasoning behind a case and arrange a later discussion with the supervisor. The plan would identify both the practice opportunity and how progress will be reviewed.

Programme evaluation needs a similar connection between feedback and action. WFME’s 2015 postgraduate standards call for trainee involvement in evaluation and for its findings to inform programme development. A programme could make that process visible through a short record showing the concern raised, the agreed response, the responsible person and the review date.

When residents return to discuss the issue, the conversation can examine what actually happened. Was the promised support available? Could the proposed activity fit into the working week? Did the feedback lead to a clear next step? Recording those answers gives the programme a basis for adjusting its response and explaining the next decision to trainees.

Read the full study on residents’ experiences of an internal medicine training programme.