Creating a Feedback Culture in the Emergency Department

A strong feedback culture is crucial across medical education, particularly within graduate medical education (GME), shaping both individual growth and departmental excellence [1]. This is especially important in the Emergency Department (ED), where real-time learning is essential. When embedded into culture and workflow, feedback strengthens clinical skills, supports professional identity formation, and fosters continuous learning [1-3]. Without an intentional framework, feedback risks becoming sporadic and ineffective, diminishing its impact on trainees and educators alike. A healthy feedback culture prioritizes frequent, formative, coaching-oriented feedback embedded into daily clinical work, while recognizing the distinct role of summative assessment for progression and accountability. In this model, feedback emphasizes process, behaviors, and skill development rather than end-of-shift judgment, supporting both psychological safety and continuous learning [2, 3]. To create a sustainable feedback culture, feedback must be normalized, reinforced through faculty development, and supported at the departmental level. In this article, we will explore strategies to establish feedback as a departmental norm, enhance engagement through structured development initiatives, and promote fairness and equity in feedback delivery. Feedback is most effective when it becomes a routine part of every shift rather than an isolated event [3-5]. When feedback is expected, frequent, and bidirectional, it fosters psychological safety, promotes self-reflection, and enhances both learner and faculty development [2, 3]. Departmental and residency leadership play a key role in shaping this environment by setting clear expectations. Learners should be empowered to seek feedback regularly, and faculty should model openness by soliciting and integrating feedback themselves [2, 3]. Onboarding materials and orientation sessions should clearly communicate the importance of feedback. In the following sections, we will discuss strategies to reinforce this culture by prioritizing feedback, cultivating a growth mindset, and addressing bias in feedback. Creating a strong feedback culture requires institutional and departmental buy-in. To cement feedback as a core value, it must be prioritized and actively promoted. Table 1 outlines strategies to promote feedback culture at both the individual and departmental level. To make feedback more impactful, perception surrounding feedback must be cultivated and positive [2-4]. Empower learners to adopt a growth mindset, and educators should model this behavior by sharing their own experiences with formative feedback. There are many ways to do this, as noted in Table 2 [2, 4, 6-9]. By addressing these challenges head-on, we can build a culture of feedback that is not only effective but also equitable, ensuring that all learners receive the support and recognition they deserve. Establishing a strong feedback culture requires a coordinated and intentional approach. Figure 1 summarizes the four strategies to build feedback culture in the ED. Departments must normalize feedback, invest in faculty development, and foster environments where learners and educators embrace feedback as a tool for growth. By addressing bias and promoting equity, we ensure that trainees receive the meaningful and constructive input they need to thrive. A healthy feedback culture catalyzes professional growth, equipping learners and educators alike with the skills they need to succeed. Sreeja Natesan: conceptualization, writing – original draft, writing – review and editing, project administration, formal analysis, data curation, supervision, resources, visualization. Megan Rivera: writing – review and editing, writing – original draft, visualization. Katarzyna Gore: writing – review and editing. Samiya Natesan-Torres: visualization. Michael Gottlieb: writing – review and editing. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.