Forward Feeding in Graduate Medical Education: Results of a National Survey

Abstract

Background and Objectives: “Forward feeding” is defined as the sharing of information regarding learner behaviors and performance outside of formal institutional committee structures. The purpose of this study was to establish baseline opinions and policies of forward feeding in family medicine residency programs. Methods: Data for this study were obtained as part of the 2015 CERA Program Directors Fall Survey. Program directors indicated whether they felt that faculty should and do engage in forward feeding. Respondents were asked to rate the importance of various types of information about learners (academic performance, clinical performance, professionalism, physical health, and mental health), reasons for promoting, and concerns regarding forward feeding on a 5-point Likert scale. Results: The overall response rate was 49% (227/461). Most agreed that faculty should (87%) and do (83%) engage in forward feeding. Concerns regarding professionalism and clinical performance were reported as most important to share. The most important reason identified for forward feeding was the early identification of struggling residents, followed by the ability to direct teaching to the resident’s specific needs, and improving the quality of feedback. Fear of creating bias was the most commonly cited concern for engaging in forward feeding, followed by fear of violating confidentiality and difficulty maintaining confidentiality. Fear of litigation was the least common concern. Conclusions: Despite concerns, the majority of program directors feel that faculty should and do engage in forward feeding. Our study confirms the importance of clinical performance and professionalism as two important themes of information shared by attendings about residents.

Learner Handover: Who Is It Really For?

“…In a similar study regarding U.S. and Canadian family medicine clerkships, Mims et al 12 found that 57% of clerkship directors stated that they forward feed information about medical students' performance difficulties to others. In the postgraduate setting, DeCastro et al 13 reported that 83% of U.S. family medicine program directors engaged in learner handover. Regardless of uptake, faculty participants in all studies expressed concerns about learner handover causing "self-fulfilling prophecies, " stigmatizing a trainee labeled as "struggling" or adding bias to future feedback and assessments.…”

“…Regardless of uptake, faculty participants in all studies expressed concerns about learner handover causing "self-fulfilling prophecies, " stigmatizing a trainee labeled as "struggling" or adding bias to future feedback and assessments. 7,[11][12][13][14] These concerns are not completely unfounded. A recent scoping review concluded that information about a learner's previous performance could bias a rater through an assimilation effect resulting in ratings that trend in the same direction as the performance information.…”

“…6,11 In addition to these formal processes, our findings resonate with DeCastro and colleagues' definition of learner handover as a process of information sharing about learners outside of formal committees. 13 In their study, 50% of information shared was through "informal conversations" and focused on professionalism and clinical performance. Our study further helps define different levels of formality: from very formal learner handover-such as information shared during competence committees-to structured exchanges between faculty members during patient handover, to more informal discussions.…”

Reflective practice: Finding synergy between psychological science and competency‐based frameworks.

“…Forward feeding may contribute to the creation of a more developmentally‐informed and comprehensive view of a trainee's performance related to self‐reflection. Although “forward feeding” may be controversial and biasing in and of itself, disclosure of key information across levels of the training community can serve to identify trainees with competence problems or potential difficulties related to reflective practice across the training continuum, so that targeted educational interventions can be designed to address trainees’ specific needs in this competency domain (Cleary, 2008; DeCastro, Mims, Stephens, & Chessman, 2019).…”

Benefits and Drawbacks of learner handover: A Scoping Review

“…The most prevalent usage of the Learner Handover revolves around smoothening out the UGME-PGME transition (Busing et al, 2018;Kassam et al, 2019;Morgan et al, 2018;Schiller et al, 2018) at 46% and the assessment of students (Dory et al, 2020;Gumuchian et al, 2020;Humphrey-Murto et al, 2021) at 39% of the studies reviewed. Use as a teaching aide to help faculty modify their teaching to the student's learning needs was also mentioned as an important utility of Learner Handover by 15% of studies (DeCastro et al, 2019;Humphrey-Murto et al, 2021).…”