Is feedback to medical learners associated with characteristics of improved patient care?

Abstract

PurposeTo investigate the association of medical learner feedback with patient management and outcomes.MethodsThe authors investigated 27 articles that utilized patient data or chart reviews as a subset of a prior feedback scoping review. Data extraction was completed by two authors and all authors reviewed the descriptive data analysis.ResultsThe studies were predominantly short-term investigations conducted in the US at academic teaching hospitals (89%) with one medical discipline (78%), most commonly internal medicine (56%). Patient-related outcomes primarily involved improved documentation (26%) and adherence to practice guidelines (19%) and were mostly measured through chart reviews (56%) or direct observation (15%). The primary method of feedback delivery involved a written format (30%). The majority of the studies showed a positive effect of feedback on the patient-oriented study outcomes (82%), although most involved a non-rigorous study design.ConclusionsPublished studies focusing on the relationship between medical learner feedback and patient care are sparse. Most involve a single discipline at a single institution and are of a non-rigorous design. Measurements of improved patient outcomes are restricted to changes in management, procedures and documentation. Well-designed studies that directly link learner feedback to patient outcomes may help to support the use of feedback in teaching clinical outcomes improvement in alignment with competency-based milestones.Electronic supplementary materialThe online version of this article (10.1007/s40037-017-0375-8) contains supplementary material, which is available to authorized users.

“It’s helpful to get the time and opportunity to discuss drug treatment; that’s what I think is the most important thing.”—A qualitative study on prescribing education in junior physicians

“…As taking care of patients is the primary, and sometimes challenging, task for the physician, a permissive and open atmosphere with the opportunity to discuss reality-based experiences and thoughts was found to be important in the educational sessions. Indeed, although high-quality evidence is lacking regarding the effects of feedback [23,24], allowing time for such interaction has been shown to be favorable for job performance [25]. Further, occupational distress, which has been reported to be relatively frequent among junior physicians [26], may be alleviated through interactive feedback sessions.…”

Can a novel constructivist theory-informed feedback intervention reduce prescribing errors ? A pre-post study

“…However, prescription charts are only one form of monitoring prescribing performance and we cannot assume, as argued by others, that this indirect outcome (i.e. fewer prescribing errors) translates to a reduction in medicine related harm and improved quality of care for patients [41]. However, our study was not powered to assess these patient-centred outcomes.…”

“…However, our study was not powered to assess these patient-centred outcomes. Whilst we have used outcomes which are generally agreed upon to be important determinants of safe and effective prescribing, designing feedback studies that relate feedback to measurable patient outcomes is inherently difficult [41].…”