The interplay between residency program culture and feedback culture: a cross-sectional study exploring perceptions of residents at three institutions

Background: Giving and receiving feedback that changes performance is influenced significantly by the clinical learning environment. This environment is multi-dimensional but includes both organizational and feedback specific dimensions. Objective: The objectives of this research were to investigate the relationship between residents’ perceptions of residency program culture and feedback culture; and whether there were differences in resident perceptions of their programs’ and feedback cultures based on their disciplines and institution. We hypothesized that residents preferred certain program culture types and that certain aspects of a residency program’s culture were related to the feedback culture. Design: Residents from six specialties at three institutions voluntarily completed two validated survey instruments (Organizational Culture Assessment Instrument [OCAI] and Feedback in Medical Education [FEEDME]-Culture survey) to assess the residency program and feedback cultures, respectively. Descriptive statistics were calculated and non-parametric tests were used to analyze the data. Results: The overall response rate was 37.9% (116/306 residents). ‘Clan’ culture was both the current and preferred culture by 49.3% and 56.8%, respectively, of the residents overall. There were differences across programs with more current ‘clan’ culture in pediatrics than in surgery (P = 0.01). Multiple regression analysis showed the Hierarchy Now culture type was significantly related to the feedback culture mean score (p = <.01). For every one unit increase in the Hierarchy Now culture type, the FEEDME-Culture mean score decreases by 0.023 units. Conclusions: The findings of this study add to the literature by describing residents’ preferences of their residency program’s culture, and providing insights into the interplay between the residency program and feedback cultures.