The Calgary Audit and Feedback Framework: a practical, evidence-informed approach for the design and implementation of socially constructed learning interventions using audit and group feedback

Abstract

BackgroundAudit and feedback interventions may be strengthened using social interaction. The Calgary office of the Alberta Physician Learning Program (CPLP) developed a process for audit and group feedback for physicians. This paper extends previous work in which we developed a conceptual model of physician responses to audit and group feedback based on a qualitative analysis of six audit and group feedback sessions. The present study explored the mediating factors for successfully engaging physician groups in change planning through audit and group feedback.MethodsTo understand why some groups were more interactive than others, we completed a comparative case analysis of the six audit and group feedback projects from the prior study. We used framework analysis to build the case studies, triangulated our observations across data sources to validate findings, compared the case studies for similarities and differences that influenced social interaction (mediating factors), and thematically categorized mediating factors into an organizing framework.ResultsMediating factors for socially interactive AGFS were a pre-existing relationship between the program team and the physician group, projects addressing important, actionable questions, easily interpretable data visualization in the reports, and facilitation of the groups that included reflective questioning. When these factors were in place (cases 1, 2A, 3), the audit and group feedback sessions were dynamic, with physicians sharing and comparing practices, and raising change cues (such as declaring commitments to de-prescribing, planning educational interventions, and improving documentation). In cases 2C–D, the mediating factors were less well established and in these cases, the sessions showed little physician reflection or change planning. We organized the mediating factors into a framework linking the factors for successful sessions to the conceptual model of physician behaviors which these mediating factors drive.ConclusionsWe propose the Calgary Audit and Feedback Framework as a practical tool to help foster socially constructed learning in audit and group feedback sessions. Ensuring that the four factors, relationship, question choice, data visualization, and facilitation, are considered for design and implementation of audit and group feedback will help physicians move from reactions to their data towards planning for change.

“I made a mistake!”: a narrative analysis of experienced physicians’ stories of preventable error

“…By offering avenues to engage in dialogue, colleagues and friends can be important sources of support for growth and development. This change can be achieved in a structured peer support program 76, formalized continuing professional development discussion groups where they can discuss their personal performance metrics or practice patterns 77,78 , or more informally outside of the clinical setting 79 . Health and wellness techniques tailored for physicians may also serve as avenues to further support this growth process.…”

How does feedback shared with interprofessional health care teams shape nursing performance improvement systems? A rapid realist review protocol

“…In addition, context can also be described with reference to the same ANT concepts: intermediaries, actors, mediators, or network can influence the mechanisms at play. However, further refinements should be considered when inquiring into a specific step of NPIS, since feedback can be contextualised within a wider sequence of processes [27, 56]. Minary et al [57] ingeneously suggest that context can be defined as endogenous and exogenous.…”

Technology-Enhanced Faculty Development: Future Trends and Possibilities for Health Sciences Education

“…For example, the University of South Pacific [ 41 ] has developed an “early warning system” to predict student performance based on online engagement whereas others have developed e-rubrics which incorporate data from online learning systems to make it actionable [ 42 ]. Perhaps similar to how physicians are starting to use their performance data to improve clinical practice [ 43 , 44 ], teachers can meet together to examine their own learning analytics to compare practice and improve teaching performance via discussion and peer support.…”