Feedback with feelings: the human complexity of expressing judgements about performance.

Feedback is an emotional business; evoking optimism, fear or disappointment, which in turn can lead to engagement, further feedback seeking or avoidance. Emotions therefore are not just background noise but are fundamental to the experience. Through conceptualising emotions as embodied, social and complex, we seek to better understand how feelings work within feedback in clinical education, beyond an individual 'managing' their emotions. In this post-qualitative study, we ask: How does the interplay between feelings and feedback unfold in specialty medical training? To this end, we conducted a focussed ethnography of feedback in intensive care medicine and surgical training in Australian tertiary-care hospitals. Thinking with theory, we traced how trainees' feelings move within and between feedback encounters through observation-based field notes and interview transcripts. We provide thick description of how feedback is saturated with feeling, integrating our findings with discussion. Supervisors expressed their judgements about trainee performance as feelings, through feelings and about feelings. And trainees responded with feelings of their own. Formal feedback particularly intensified feelings, which 'stuck with' trainees, leading to action, including avoidance. Feelings served to strengthen relationships and reinforce social hierarchies both within and beyond the supervisor-trainee dyad. We infer that the judgements made in and around feedback - such as appraisal of source credibility, assessment of performance quality, and deciding future actions - are themselves fundamentally entangled with feelings. A first step to remedy the desire to 'manage' emotions through 'putting them away' is to acknowledge their presence in clinical learning environments.