The integrative feedback tool: assessing a novel feedback tool among emergency medicine residents

Abstract

Feedback is critical to the growth of learners. However, feedback quality can be variable in practice. Most feedback tools are generic, with few targeting emergency medicine (EM). We created a feedback tool designed for EM residents, and this study aimed to evaluate the effectiveness of this tool. Methods:This was a single-center, prospective cohort study comparing feedback quality before and after introducing a novel feedback tool. Residents and faculty completed a survey after each shift assessing feedback quality, feedback time, and the number of feedback episodes. Feedback quality was assessed using a composite score from 7 questions, which were each scored 1-5 points (minimum total score, 7 points; maximum, 35 points). Pre-and post-intervention data were analyzed using a mixed-effects model with the treatment of study participants as having correlated random effects. Results:Residents completed 182 surveys and faculty members completed 158 surveys. The use of the tool was associated with improved consistency in the summative score of effective feedback attributes as assessed by residents (P = 0.04) but not by faculty (P = 0.259). However, most of the individual scores for attributes of good feedback did not reach statistical significance. With the tool, residents perceived that faculty spent more time providing feedback (P = 0.04) and that the delivery of feedback was more ongoing throughout the shift (P = 0.02). Faculty felt that the tool allowed for more ongoing feedback (P = 0.002), with no perceived increase in the time spent delivering feedback (P = 0.833). Conclusion:The use of a dedicated tool may help educators provide more meaningful and frequent feedback without impacting the perceived required time needed to provide feedback. Capsule SummaryWhat is already known: Feedback is not always focused on or formally taught as part of graduate medical education, and, as a result, many clinical faculty may not have significant training in the matter. Furthermore, many faculty may not have the time to prioritize keeping up to date with evolving literature in medical education given their other clinical and administrative commitments. This can lead to significant variability in how feedback is delivered and result in learner dissatisfaction with the quality of feedback provided as well as missed opportunities for growth and development. What is new in the current study:To address this need, we developed a novel feedback tool to guide feedback delivery and allow opportunities for integration into the shift. Using a structured tool, residents could identify their specific learning objectives from a full list modeled after the EM Milestones. Informed by Kolb's theory of experiential learning, the residents then receive real-time feedback on specific instances after a patient encounter, alter their practice, and see if any changes they made have been effective. Having the learner choose the specific skills in an organized system, with clearly defined and achievable goals to work on during their shift, may prevent...