Resident Perspective on Feedback and Barriers for Use as an Educational Tool

Abstract

Background Feedback in physician graduate medical education is not clearly defined. Some parties may view questioning as a form of feedback, others the conversations over lunch, some the comments in the operating room (OR), and still others the written evaluation at planned meetings. The lack of clarity in defining what constitutes feedback is concerning when this is considered a fundamental means of education to enhance practices and care for patients. If residents do not recognize they are receiving feedback, or the response to feedback is met with opposition, then feedback as an educational device can be limited. For this manuscript, feedback is defined as written or verbal comments regarding medical knowledge, performance, technique, or patient care. Objective This study attempts to identify barriers to feedback by identifying attitudes toward feedback processes through a questionnaire. Methods Ten questions were provided to residents at a single institution representing, emergency medicine, family medicine, internal medicine, neurology, and neurosurgery during the 2017-2018 academic year. Response was voluntary and the study was granted exemption by local institutional review board since no identifying information was collected to link responses to specific residents. Questions were formulated to identify how positive or negative a resident felt toward specific aspects of feedback. Results Of the possible 84 resident respondents, 40 residents participated reflecting a response of approximately 48%. Questionnaires revealed that 22.5% of respondents found feedback to be a stressful event. Sixty-seven point five percent (67.5%) of resident respondents associated the prompt that they are about to receive feedback as concerning. Only 2.5% of residents identified a meeting with the program director as a sign that the resident may be doing well. Appointments for feedback were viewed as a positive event in 12.5% of respondents. Ninety-five percent (95%) of residents do not feel that all feedback will affect their permanent record. Ten percent (10%) of residents identified receiving feedback as a positive event. Ninety-five percent (95%) of residents indicated that they have actively tried to change behavior or practices based on feedback. Forty percent (40%) of residents found themselves censoring “negative” feedback. Conclusions Barriers to feedback include the inability to present sensitive subjects in a constructive manner and superficial relationships between the evaluator and resident physician. Research directed at addressing these barriers could lead to improved use of feedback as an educational tool.

Cut Down, Continue, Commence: Resident and Attending Perceptions of a Standardized, Face-to-Face Feedback System

“…Previous authors have shown that higher trainee satisfaction with feedback may not relate to the actual quality of feedback (Boehler et al, 2006). Additionally, there are well-reported discrepancies between resident and attending perceptions of feedback in terms of quality, frequency, or duration (Sender Liberman et al, 2005;Carr et al, 2018;Albano et al, 2019). As suggested by this study, the implementation of a standardized feedback system like the 3 C's may not immediately improve these issues.…”

“…Previous approaches to address formative feedback during residency training have utilized the implementation of standardized feedback systems (Peccoralo et al, 2012;Wilkinson et al, 2013). These systems can include faculty development (Wilkinson et al, 2013), conversation guides (Peccoralo et al, 2012), or standardized templates (Peccoralo et al, 2012;Hoon et al, 2015;Albano et al, 2019). There is growing evidence that these methods may improve trainee performance, but their implementation is not well studied (Veloski et al, 2006).…”

Better Decision-Making: Shared Mental Models and the Clinical Competency Committee

“…28,43 Evidence that Milestones and entrustable professional activities (EPAs) provide mental models shared between assessors and learners is mixed. 33,[44][45][46][47][48][49] Part of the challenge is structural: Milestones and EPAs that are broadly defined are susceptible to variable interpretation. 49,50 This variability is affected by the larger challenge of the lack of an SMM of any instrument of assessment and the consequences of that assessment, which involves a process akin to negotiation.…”

Percepções de docentes e discentes sobre feedback em estágios práticos no curso de medicina

“…Feedback -ou devolutiva -pode ser definido como a transferência de dados observados pelos preceptores durante a prática médica, de modo a contextualizar o saber cognitivo, a habilidade prática e a tomada de decisão, e verificar se os objetivos do aprendizado foram atingidos, visando a uma reflexão do estudante para que ele reconstrua seus conhecimentos e altere seu modo de agir, com o propósito de melhorar sua performance para que atinja as competências necessárias à profissão em prol do paciente 8 . As devolutivas são importantes para os estudantes refletirem sobre a própria performance e o desempenho desejado, de modo que possam buscar suporte para a melhoria de suas desenvolturas em ambientes de prática.…”

“…Para as devolutivas serem efetivas, é necessário que haja entrosamento entre o professor e o aluno, clareza na transmissão, entendimento do discente e identificação dos objetivos do aprendizado desejados tanto pelo estudante quanto pelo preceptor 8 . Além disso, influenciam na efetividade da devolutiva o tempo destinado à observação, o local em que o feedback é realizado e o conteúdo e a forma de transmissão dele 10 .…”