Muirne Spooner¹
1 Royal College of Surgeons in Ireland University of Medicine and Health Sciences 

Background
Medical education sees student migration and Western-devised programmes at international campuses(1). Feedback is increasingly recognised as complex and culturally contextualised. To understand the cultural factors which impact learners’ response to feedback, we explored medical students’ perspective in our unique setting of three transnational campuses with over ninety nationalities. 

Summary of work
This study was conducted at one medical school with three campuses in Western Europe, the Middle East and East Asia. Final-year medical students participated in 57 semi-structured interviews, which were analysed using template analysis. Key themes were compared across the three medical campuses and across student groups of varying national backgrounds. 

Results Themes were critically reviewed through Hofstede’s Dimensions, Small Cultures and Figured Worlds theories. Learners from all backgrounds and sites describe shared experience ofadistinctivecultureinMedicinewhichiscriticism-focussed andhierarchical.Learnersself- author as passive recipients with “stern”, senior clinicians and as peer collaborators with accessible faculty supervisors. While national cultural background rarely influenced feedback responses, early life feedback experiences commonly affected preferences. Harnessing peer support was highly valued in making the most of feedback. 

Discussion
While feedback models champion collaboration, in practice medical students’ are challenged by an inherent hierarchical culture. Learners adapt in two ways to this culture. They shifting their response and identity according to the supervisor role. They lean on peers to make sense of feedback and emotionally support in challenging environments. 

Conclusion
Cultural factors significantly impact learner feedback experiences, with distinctive mistreatment culture a common theme across diverse contexts.. National background appears of limited value in influencing feedback, but early-life experiences are under-explored in considering learner feedback perspectives. 

Take-home
Educators should consider how to embed psychological safety in feedback practices 

References (maximum three) 

1. Brouwer, E., Frambach, J., & Driessen, E. (2017). Mapping the scope of internationalized medical education. Paper presented at the The Network Towards Unity for Health Annual Conference.