Introduction: Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners’ goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality.

Methods: We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations.

Findings: Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one’s image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted.

Discussion: Our findings offer a nuanced understanding of the complexities that influence learners’ approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.