Clinical teaching feedback on institute of medicine quality domains: self-reported perspectives of emergency physicians in Taiwan

This study examines how emergency medicine clinical teachers in Taiwan understand and describe the six Institute of Medicine (IOM) healthcare quality domains into their teaching feedback discourse, revealing their dynamic trade-offs in high-pressure environments to address the shift toward competency-based medical education. A qualitative phenomenological study was conducted. Semi-structured interviews were conducted with 14 emergency physicians (each with > 5 years of teaching experience). Data were transcribed verbatim, thematically analyzed, and categorized according to the six IOM quality domains using a dual-metric approach (participant count and reference count). “Patient-centeredness” and “safety” were addressed most frequently in feedback, demonstrating the highest consensus and depth. “Effectiveness” and “timeliness” shared a high consensus but had lower reference frequencies. “Equity” and “efficiency” demonstrated a relatively lower consensus. This distribution indicates that clinical teachers do not merely neglect specific domains but make practical teaching adjustments amidst the resource constraints of emergency care. Aligning with competency-based medical education, this study highlights that self-described feedback serves not only as an assessment tool but also as a transmission of professional values and the hidden curriculum. Although clinical teachers rarely use formal IOM terminology, their described feedback language substantively reflects the practical value prioritization perceived within the constraints of the high-pressure emergency environment. These findings address a literature gap regarding quality-oriented feedback in emergency medicine. Future faculty development programs could further explore how to enhance clinical teachers’ understanding of diverse quality domains and develop contextualized feedback strategies. This could help bridge the gap between quality frameworks and teaching applications, ultimately balancing educational effectiveness with clinical feasibility.