Feedback, the various tasks of the doctor, and the feedforward alternative.

OBJECTIVES: This study aims to alert users of feedback to its dangers, explain some of its complexities and offer the feedforward alternative.
METHODS: We review the damage that feedback may cause to both motivation and performance. We provide an initial solution to the puzzle of the feedback sign (positive versus negative) using the concepts of promotion focus and prevention focus. We discuss additional open questions pertaining to feedback sign and consider implications for health care systems.
RESULTS: Feedback that threatens the self is likely to debilitate recipients and, on average, positive and negative feedback are similar in their effects on performance. Positive feedback contributes to motivation and performance under promotion focus, but the same is true for negative feedback under prevention focus. We offer an alternative to feedback--the feedforward interview--and describe a brief protocol and suggestions on how it might be used in medical education.
CONCLUSIONS: Feedback is a double-edged sword; its effective application includes careful consideration of regulatory focus and of threats to the self. Feedforward may be a good substitute for feedback in many settings. © Blackwell Publishing Ltd 2010.