Unobserved Observers: Nurses’ Perspectives About Sharing Feedback on the Performance of Resident Physicians

Bhat, Chirag; LaDonna, Kori A; Dewhirst, Sebastian; Halman, Samantha; Scowcroft, Katherine; Bhat, Silke; Cheung, Warren J.

doi:10.1097/acm.0000000000004450

Cited by 4 publications

(15 citation statements)

References 59 publications

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“…Prior studies have found that nurses are poised to provide residents with feedback on their communication skills, collaboration, and professionalism. 7,9,10,[17][18][19] Our study similarly found collaboration and communication as domains on which nurses are well-equipped to provide feedback and further adds to the literature by elucidating the specific behaviors within these broader categories that nurses can assess. While residents are often assessed on their medical knowledge by supervising attendings and peers, both nurse and resident participants felt that nurses should not be asked to assess residents on their medical knowledge or clinical decision-making, which also aligns with prior work.…”

Section: Discussionsupporting

confidence: 58%

“…6 Nurses, specifically, have perspectives that differ from those of attending physicians. 7 Given that many of a resident's workplace activities are not directly observed by a physician supervisor, nursing assessments can provide reliable and different perspectives on competencies such as communication and professionalism. 8 For example, recent studies found that internal medicine and emergency medicine nurses could provide feedback on residents' efficiency, kindness, communication, advocacy, leadership, collaboration, and professionalism.…”

Section: Introductionmentioning

confidence: 99%

“…8 For example, recent studies found that internal medicine and emergency medicine nurses could provide feedback on residents' efficiency, kindness, communication, advocacy, leadership, collaboration, and professionalism. 7,9,10 A randomized controlled trial found that nursing feedback did lead to improvement in pediatric residents' communication skills and professional behavior. 11 Importantly, residents have found nursing feedback to be valuable.…”

Section: Introductionmentioning

confidence: 99%

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A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents

Dunbar

Chiel

Doherty

et al. 2022

Journal of Graduate Medical Education

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Background Resident feedback is generally elicited from attending physicians, although nurses can also provide feedback on distinct domains. Physicians may be hesitant to accept feedback from nurses if they perceive that nurses are being asked about areas outside their expertise. Understanding specific resident behaviors that nurses are best suited to assess is critical to successful implementation of feedback from nurses to residents. Objective To understand specific resident behaviors nurses are uniquely positioned to assess from the perspectives of both nurses and residents. Methods We performed a qualitative study using thematic analysis of 5 focus groups with 20 residents and 5 focus groups with 17 nurses at a large free-standing children's hospital in 2020. Two reviewers developed a codebook and subsequently analyzed all transcripts. Codes were organized into themes and subthemes. Thematic saturation was achieved prior to analyzing the final transcript. Results We identified 4 major themes. Nurses are positioned to provide feedback: (1) on residents' interprofessional collaborative practice; (2) on residents' communication with patients and their families; and (3) on behalf of patients and their families. Within each of these, we identified subthemes noting specific behaviors on which nurses can provide feedback. The fourth theme encompassed topics that may not be best suited for nursing feedback—medical decision-making and resident responsiveness. Conclusions Nurses and residents described specific resident behaviors that nurses were best positioned to assess.

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents

Dunbar

Chiel

Doherty

et al. 2022

Journal of Graduate Medical Education

View full text Add to dashboard Cite

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“…17 By doing so, attending physicians legitimise the guiding role of nurses, thereby helping residents understand the valuable contributions nurses can make to their workplace learning and professional development. 17,22,55 Finally, given the influence of power and hierarchy, our results suggest that establishing workplace structures, such as formal curricula, could enable meaningful interprofessional education and collaboration. 8,55…”

Section: Nursesmentioning

confidence: 79%

“…9,19 Other studies have highlighted nurses' unique feedback perspective on residents' performance regarding communication with patients and families as well as their collaboration within the health care team. [20][21][22] Despite this empirical evidence pointing to the highly relevant role of nurses in residents' learning, our understanding of nurses' role remains underexplored. 8 A more profound understanding of nurses' role in residents' learning may help further optimise residents' workplace learning.…”

Section: Introductionmentioning

confidence: 99%

Exploring nurses' role in guiding residents' workplace learning: A mixed‐method study

et al. 2022

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Introduction: Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions.Methods: This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likertscale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using ANOVA. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions. Results: Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, Previous presentations Preliminary results were presented at the Association of Medical Education in Europe (AMEE) (online).

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Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units

Cheng,

Molinaro,

Ott

et al. 2023

Academic Medicine

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Purpose: Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs “on the job,” often without the formative, multisource feedback trainees need. To generate insight into how on the job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored. Method: The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n=14) and health care providers (n=10) from 2 Canadian NICUs were invited to participate in semi-structured interviews informed by rich pictures—a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018-2021. Results: According to participants, misalignment between parents’ and trainees’ communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees’ experiential learning should not trump parents’ well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so called ‘soft’ skills like communication during their training. Conclusions: Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome in order to succeed.

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Unobserved Observers: Nurses’ Perspectives About Sharing Feedback on the Performance of Resident Physicians

Cited by 4 publications

References 59 publications

A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents

A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents

Exploring nurses' role in guiding residents' workplace learning: A mixed‐method study

Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units

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