Purpose
Feedback is essential for learning and developing competence. A common myth of competency-based assessment is that all feedback must be positive. In this study, we examined narrative feedback on workplace-based assessment forms (FieldNotes) to identify patterns in feedback about resident performance gaps. 

Methods
We used learning analytics through secondary data analysis to examine seven years (July 2016 to June 2023) of de-identified FieldNotes at one mid-sized Canadian Family Medicine residency program. FieldNotes include a narrative summary of feedback shared with a resident after direct observation, as well as an indication of resident competence (Progress Level). We extracted FieldNotes where the indicated Progress Level was “Stop, Important Correction” (“Stop”) for analysis. 

Results
Of all FieldNotes examined (N=42,383), 2% were designated as “Stop”. Within any academic year, 30% of learners received a “Stop” FieldNote. The majority of “Stop” FieldNotes included feedback about communication skills, equally split between verbal and written communication. The most frequently addressed topics in the feedback on “Stop” FieldNotes were identifying a sick patient with respect to vital sign abnormalities, abdominal pain, trauma surveys, neurological physical examination, delivering infants, gynecologic procedures, suturing, intubation, charting issues (e.g., incomplete documentation of treatment plan), and time management efficiency in clinic.

Conclusion
Our results suggest that feedback in competency-based assessment does include corrective feedback identifying gaps in competence. Sharing feedback with learners about areas to improve is beneficial to the development of competence and should be normalized in training programs as good assessment practice that does not reflect poorly on a learner.