gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Beliefs for successful feedback communication

editorial editorial

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  • corresponding author Michaela Wagner-Menghin - Medizinische Universität Wien, Universitätsklinik für Psychiatrie und Psychotherapie, Klinische Abteilung für Sozialpsychiatrie, Wien, Austria

GMS J Med Educ 2024;41(3):Doc34

doi: 10.3205/zma001689, urn:nbn:de:0183-zma0016895

This is the English version of the article.
The German version can be found at:

Received: May 16, 2024
Accepted: May 16, 2024
Published: June 17, 2024

© 2024 Wagner-Menghin.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at


“You Think Failure Is Hard? So Is Learning From It” ([1], p.1511). Although we intuitively agree that we learn from successes and failures, we realize that the very experience of failure can be stressful. To learn from our failures, we need to become or be made aware by external feedback regarding the difference between the result of our actions and the objective performance standards that define HOW we act and our values and needs that determine WHY we act. In this context, the negative emotions triggered by failure are initially experienced as stressful, while these emotions also influence motivation and performance in further actions [2]. This can further increase the stress [1], especially if the request to analyze the failure makes it impossible to down-regulate negative emotions by distracting oneself, leaving the situation, or suppressing the expression of the reaction.

From the perspective of emotion and motivation psychology, the high emotional involvement in reflection on action arises because the metacognitive processing of the HOW simultaneously activates the self-related, more stressful metacognitions related to the WHY of the action. To remain capable of acting, i.e. to be able to optimize the HOW of action, negative emotions must be down-regulated [3], especially if they were triggered by self-related metacognitions.

Strategies for effective feedback communication that aim to activate as few self-related metacognitions as possible were proposed some time ago for both theoretical [4] and practical teaching in simulations [5] and in the workplace [6], as well as for works (e.g. scientific papers) [7], [8]. In addition to being “timely”, all approaches emphasize the principles of “action-guiding and/or knowledge-enhancing” and “respectful/open” as the basis for effective feedback communication. However, it is doubtful whether these strategies achieve the goal of preventing reflection at the self-level, which is responsible for negative emotions. A recent study on what health professions educators associate with the term feedback concludes that although they are aware of the benefits of feedback for optimizing one’s actions, they mainly remember negative emotions in connection with giving and receiving feedback [9]. New strategies that make giving and receiving feedback more pleasant for all agents involved in the communication are therefore still needed to increase well-being in the context of education and work. Given the strong involvement of the self in the form of personal values and needs [10] in the development of negative emotions in the event of failure, it is important to cultivate values and needs in the self that make it easier for us to learn from failure. Three beliefs could be helpful for those giving and receiving feedback because the associated values and needs provide less cause for negative feelings to arise in the event of failure and make it easier to deal with them:

  • Skills develop incrementally in exchange with others: Many small steps of individual and joint reflection of experienced result-standard discrepancy expand existing skills. The attitude of striving for continuous development protects against negative emotions or helps to overcome them in feedback communication [11].
  • Joint reflection on action or works triggers emotions in all participants: Since reflection on action also activates reflection on the self, all participants must accept their own and others' emotions in their respective professional roles. Learners are encouraged to develop a repertoire for dealing constructively with their reactions to critical feedback [11]. This encouragement is echoed by teachers whose role involves giving critical feedback. They need a repertoire for dealing constructively with their own and others’ reactions, possibly similar to the situation of giving bad news.
  • Emotion regulation is achieved by redirecting attention from the self to planning the action: Strategies for distancing from the self include formulating the experience as a recommendation for future actions for oneself or other learners. Actively visualizing beneficial beliefs is also recommended [1].

The complex relationship between self-awareness, motivation, and performance makes it difficult to predict what internal and external feedback about success and failure will trigger in a person. Values and needs that protect the self from harm when experiencing and reflecting on failure can support learning from failure by facilitating acceptance of the outcome and emotions, as well as redirection of attention. Developing and evaluating training opportunities for these social skills is therefore an ongoing important task for medical and health professions training research.

As such, it is promising to see that two articles in this issue are dedicated to the topic of social skills training. A workshop with improvisational theater activities presented by Minow et al. [12] increases self-assessed competence for interprofessional teamwork and error management by establishing a no-blame culture. The helical, integrated, longitudinal communication curriculum with simulated patients comprising five terms presented in the evaluation study by Zerbini et al. [13] allows medical students to experience an increase in their competence and internalize the importance of empathic care for patients. The results of the pilot study by Knorr et al. [14] on the use of a Canadian Situational Judgment Test for applicants to German medical degree programs are interesting in the context of curriculum development. The test could be used in the future to evaluate interventions on training social skills.

Two studies in the current issue illustrate how important the learning environment is to live the belief that “skills develop incrementally in exchange with others”. The medical students in their practical year and doctors in training surveyed by Dronia et al. [15] on knowledge and skills in palliative care stated that they benefited most from practicing skills in small groups. The importance of integration into the working and learning community of a clinical team is shown by the results of Homberg et al. [16], who investigate the effect of experience in the surgical section of the internship year on the desire to begin surgical specialty training. Although male and female students reported a similar number of positive and negative experiences, the latter felt less well integrated into the work and the team and were less likely to choose surgical specialty training.

The notion that exchange and reflection also inspire development beyond skills training is illustrated by four papers in this issue. The academization of midwifery education prompts the DACH Association for Medical Education’s (GMA) special interest group on Midwifery Sciences to advocate joint development of courses between the curriculum providers [17] and to reflect on the professional and educational consequences resulting from the competence objectives stated in the professional act [18]. An optimistic result of the work of Juschka et al. [19] in terms of exchange, cooperation and reflection is that there are already several offers for interprofessional education of students from midwifery and medical degree programs in DACH, in which students learn together. Finally, it is to be hoped that more curriculum providers will decide to reflect on feedback on their curricula, as presented by Kunz et al. [20] Graduates of the Freiburg medical curriculum are asked for feedback 1.5 years after graduation on the applicability of what they have learned when entering the profession to inform modifications to the curriculum based on the needs of those entering the profession.

Many thanks to all authors for publicly reflecting on their successes and failures. Best wishes to all readers and future authors in receiving the findings and implementing new ideas.

Competing interests

The author declares that she has no competing interests.


Eskreis-Winkler L, Fishbach A. You Think Failure Is Hard? So Is Learning From It. Perspect Psychol Sci. 2022;17(6):1511-1524. DOI: 10.1177/17456916211059817 External link
McConnell MM, Eva KW. The role of emotion in the learning and transfer of clinical skills and knowledge. Acad Med. 2012;87(10):1316-1322. DOI: 10.1097/ACM.0b013e3182675af2 External link
Kuhl J, Beckmann J. Volition and Personality: Action Versus State Orientation. Seattle u.a.: Hogrefe & Huber; 1994.
Hattie J, Timperley H. The power of feedback. Review. Rev Educ Res. 2007;77(1):81-112. DOI: 10.3102/003465430298487 External link
Rudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008;15(11):1010-1016. DOI: 10.1111/j.1553-2712.2008.00248.x External link
Milne DL. Evidence-based clinical supervision: Principles and practice. Hoboken: Wiley-Blackwell; 2009. p.272-xi.
Azer SA, Ramani S, Peterson R. Becoming a peer reviewer to medical education journals. Med Teach. 2012;34(9):698-704. DOI: 10.3109/0142159X.2012.687488 External link
Seeber M. How do journals of different rank instruct peer reviewers? Reviewer guidelines in the field of management. Scientometrics. 2020;122(3):1387-1405. DOI: 10.1007/s11192-019-03343-1 External link
Alansari R, Lim PW, Ramani S, Palaganas JC. What do you think of when you hear the word 'feedback'? A reflective thematic analysis study of interviews. Clin Teach. 2024;21(3):e13696. DOI: 10.1111/tct.13696 External link
Rogers CR, Rosenberg RL. Die Person als Mittelpunkt der Wirklichkeit. 4. Auflage. Stuttgart: Klett Cotta; 2019.
Carless D, Boud D. The development of student feedback literacy: enabling uptake of feedback. Ass Eval Higher Educ. 2018; 43(8): 315-1325. doi:10.1080/02602938.2018.1463354 External link
Minow A, Gandras K, Wagner J, Westermann J. Good ideas for teaching: Design and implementation of the communication workshop “me as team member” for third-year medical students. GMS J Med Educ. 2024;41(3):Doc25. DOI: 10.3205/zma001680 External link
Zerbini G, Reicherts P, Reicherts M, Roob N, Schneider P, Dankert A, Greiner SK, Kadmon M, Lechner V, Roos M, Schimmel M, Strube W, Temizel S, Uhrmacher L, Kunz M. Communication skills of medical students: Evaluation of a new communication curriculum at the University of Augsburg. GMS J Med Educ. 2024;41(3):Doc26. DOI: 10.3205/zma001681 External link
Knorr M, Mielke I, Amelung D, Safari M, Gröne OR, Breil SM, MacIntosh A. Measuring personal characteristics in applicants to German medical schools: Piloting an online Situational Judgement Test with an open-ended response format. GMS J Med Educ. 2024;41(3):Doc30. DOI: 10.3205/zma001685 External link
Dronia MC, Dillen K, Elsner F, Schallenburger M, Neukirchen M, Hagemeier A, Hamacher S, Doll A, Voltz R, Golla H. Palliative care education and knowledge transfer into practice – a multicenter survey among medical students and resident physicians in Germany using a mixed-methods design. GMS J Med Educ. 2024;41(3):Doc27. DOI: 10.3205/zma001682 External link
Homberg A, Narciß E, Obertacke U, Schüttpelz-Brauns K. Surgical experiences of final-year undergraduates and the impact on their career aspiration stratified by sex/gender. GMS J Med Educ. 2024;41(3):Doc28. DOI: 10.3205/zma001683 External link
Plappert CF, Bauer NH, Dietz-Schwonberg K, Grieshop M, Kluge Bischoff A, Zyriax BC, Striebich S. Academic education of midwives in Germany (part 1): Requirements for bachelor of science programmes in midwifery education. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA). GMS J Med Educ. 2024;41(3):Doc33. DOI: 10.3205/zma001688 External link
Striebich S, Bauer NH, Dietze-Schwonberg K, Grieshop M, Kluge-Bischoff A, Zyriax BC, Plappert CF. Academic training of midwives in Germany (part 2): Opportunities and challenges for the further development of the profession of midwifery. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA). GMS J Med Educ. 2024;41(3):Doc32. DOI: 10.3205/zma001687 External link
Juschka ML, Agricolas CJ, Neumann FA, Mohr S, Zyriax B. C. Status quo of interprofessional education for midwifery and medical students in Germany, Austria, and Switzerland. GMS J Med Educ. 2024;41(3):Doc31. DOI: 10.3205/zma001686 External link
Kunz K, Köpper H. Medical studies at the University of Freiburg in retrospect – study conditions, study quality and skills acquisition from the perspective of graduates. GMS J Med Educ. 2024;41(3):Doc29. DOI: 10.3205/zma001684 External link