Education Columns

by Ashley Mitton, PsyD, Eastern Maine Medical Center, Bangor, ME; Jenna Mullarkey, PsyD, UMass Chan Medical School, Worcester, MA

Abstract

Feedback in family medicine residency should aim to provide specific, behaviorally-based targets to support both patient care and learners’ needs. The purpose of this study is to develop and implement a didactic approach to giving and receiving feedback during inpatient service. The aims of the project are to a) teach resident learners to provide team members with feedback, and b) utilize the feedback to develop collaborative goals for the remainder of time on the inpatient service. Results demonstrated that there was increased resident knowledge and confidence around giving and receiving feedback in a team-based, multidisciplinary setting.

Literature Review

Review: Residents on a family medicine inpatient services are often met with long hours, complex patients, and various interpersonal dynamics. Feedback at regular intervals is a competency required by all ACGME programs. Studies with attending physicians have found that team-based feedback provides novel, actionable points, and that initial trepidation around such a process fades as the program continues ^1,2. Residents also report that peer feedback is important and valuable in their training ³. Research has demonstrated that when asked, residents have a propensity to provide peers with positive feedback ⁴, providing important reinforcement for continuation of positive behaviors. Residents also tend to provide peers with constructive feedback that is actionable, often focusing on subcompetencies of patient care and communication, which can go missed when assessed by faculty ^{5, 6, 7}.

Feedback is best provided in a space of shared trust. Notable features of successful feedback programs include consistency with how feedback is delivered, framed to include what behaviors should be continued, what behaviors should be stopped, and what behaviors should be started, with an overall emphasis to create more optimal outcomes ⁸.

Hypothesis

This study implemented a brief feedback didactic using this frame and then allowed residents to provide each other with specific, behaviorally based feedback on what was working well, what was not working well, and what action steps they wanted to change by the end of the block. Residents were then asked if the session was beneficial. It is hypothesized that resident feedback will have improved over the one-month rotation in the areas of confidence about giving feedback, knowledge of how to give feedback, and that the team will have produced more collaborative, implementable goals.

Methods

Curriculum development and retrospective survey review. Setting: Inpatient family medicine service. Intervention: Brief (10 minute) didactic on structure and purpose of feedback given, followed by 30-minute group discussion of team strengths, weaknesses, and collaborative goal development moderated by aforementioned BH faculty. Participants: 36 family medicine residents, four psychiatry residents split across one-month block rotations. Measures/Outcomes: Three-question anonymous paper survey given the week following the presentation to gather resident knowledge, confidence, and changes made as a result of the session. The survey had a five-point Likert scale ranging from strongly agree (coded as 2) to strongly disagree (coded as -2), with neutral coded as zero.

Results

Data was collected for approximately four months, with a total of 17 responses. Other results were not able to be recorded, as residents were on night shifts or in continuity clinics when the paper surveys were given.

Distribution of Responses

Response Means

Conclusion

Results indicate that this team-based feedback session generally led to improved confidence and knowledge in how to provide feedback. Additionally, residents found that after discussing action items and making a plan, they were typically able to follow through with that plan for the remainder of their inpatient rotation. Consistent with previous research, this study demonstrated how feedback can become a normal and helpful part of resident training on an inpatient service. One limitation to this study is that not all residents who participated in the didactic session were able to be surveyed due to varying schedules, thus not all who received the training were able to share whether they found the session to be helpful. Another limitation was that surveys were brief to increase completion, but as a result lacked specificity regarding what was the most or least important part of the session. Future research could potentially focus on seeing if team-based feedback could be beneficial across other settings, such as an ambulatory care setting.

References 

1. Bhansali P, Goldman E. (2019) A novel peer feedback programme of family-centered rounds. Clin Teach ;15(6):478-482. doi: 10.1111/tct.12742
2. Francois J, Sisler J, Mowat S. (2018). Peer-assisted debriefing of multisource feedback: an exploratory qualitative study. BMC Med Educ.; 18(1):36. doi: 10.1186/s12909-018-1137-y.
3. De La Cruz MS, Kopec MT, Wimsatt LA. (2015) Resident Perceptions of Giving and Receiving Peer-to-Peer Feedback. J Grad Med Educ.;7(2): 208-13. doi: 10.4300/JGME-D-14-00388.1.
4. Bing-You R, Varaklis K, Hayes V, Trowbridge R, Kemp H, McKelvy D. (2018). The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher-Learner Feedback Exchange. Acad Med.; 93(4):657-663. doi: 10.1097/ACM.0000000000001927.
5. Ende J. (1983). Feedback in clinical medical education. JAMA.; 250(6):777-81.
6. Page C, Reid A, Brown MM, Baker HM, Coe C, Myerholtz L. (2022). Content Analysis of Family Medicine Resident Peer Observations. Fam Med; 52(1):43-47. doi: 10.22454/FamMed.2020.855292
7. Voyer S, Cuncic C, Butler DL, MacNeil K, Watling C, Hatala R. (2016). Investigating conditions for meaningful feedback in the context of an evidence-based feedback programme. Med Educ.; 50(9):943-54. doi: 10.1111/medu.13067.
8. Sherman RO. (2019) The Art of Giving Feedback. Am J Nurs; 119(9):64-68. doi: 10.1097/01.NAJ.0000580292.79525.d2.