Authors’ Response to Drs Bell and Kozakowski

We thank Drs Bell and Kozakowski for their interest in our narrative review and for their thoughtful and positive letter to the editor. We appreciate how Drs Bell and Kozakowski highlighted some of our key observations concerning learners actively seeking out “critical feedback to help them accomplish the competency goals.” We were particularly delighted to see that our message concerning the importance of studying “the content of feedback, the process by which it is delivered, and the perceived quality of teacher-learner relationship on educational and clinical outcomes” was well received.

Based on the thematic analysis of the literature included in our narrative review, we did indeed identify that the family medicine educational community faces several challenges with CBME assessment, including the need for and challenges to feedback for both learners and assessors (faculty).1 What is of particular interest is that those challenges go beyond family medicine education and reflect some of the current trends in the general medical educational literature regarding the feedback process2,3 and the importance of peer-to-peer feedback for teaching.5 The latter phenomenon is something our team is currently investigating. Our preliminary results suggest that family medicine is leading the field in terms of producing scholarly work in the areas of needs assessment, identifying the benefits of feedback, and in engaging in innovative peer-to-peer feedback design and practice. We believe that these three aspects of our inquiry into peer-to-peer feedback will build upon our CBME narrative review by complementing the current focus on competency definitions and outcomes, by focussing on the process of their performance and effects on and within the teacher-student dyad. As Bell and Kozakowski point out, “further work in CBME must include attention to the process of CBME in addition to stating and assessing outcome competencies.” We believe that the time is right to pursue this agenda. We would argue that CBME is fundamentally performative in nature, in that CBME is constituted by how we practice it. In turn, the conditions under which CBME is practiced and the way it is performed affect the perception of its value for those involved, and, most importantly, shapes the nature of the way it is delivered and received. Ultimately, a greater understanding of the factors relating to CBME implementation effectiveness will lead to better design and performance as well as greater efficacy.

Again, we thank Drs Bell and Kozakowski for their letter. This is a clear call to action to promote the personal and professional development to achieve effective feedback for learners and faculty. We believe that in order to provide truly effective feedback and to build a coherent and integrated system of competency-based assessment, evaluation of the key contextual factors across the continuum of education to practice is of increasing importance in the field of continuing professional development.1