Resident identification of feedback and teaching on rounds

Medical residents and attending physicians’ perceptions of feedback and teaching in the United States: a qualitative study

PURPOSE

Residents and attendings agree on the importance of feedback to resident education. However, while faculty report providing frequent feedback, residents often do not perceive receiving it, particularly in the context of teaching. Given the nuanced differences between feedback and teaching, we aimed to explore resident and attending perceptions of feedback and teaching in the clinical setting.

METHODS

We conducted a qualitative study of internal medicine residents and attendings from December 2018 through March 2019 at the Massachusetts General Hospital to investigate perceptions of feedback in the inpatient clinical setting. Residents and faculty were recruited to participate in focus groups. Data were analyzed using thematic analysis to explore perspectives and barriers to feedback provision and identification.

RESULTS

Five focus groups included 33 total participants in 3 attending (n=20) and 2 resident (n=13) groups. Thematic analysis of focus group transcripts identified 7 themes which organized into 3 thematic categories: (1) disentangling feedback and teaching, (2) delivering high-quality feedback, and (3) experiencing feedback in the group setting. Residents and attendings highlighted important themes in discriminating feedback from teaching. They indicated that while feedback is reactive in response to an action or behavior, teaching is proactive and oriented toward future endeavors.

CONCLUSION

Confusion between the critical concepts of teaching and feedback may be minimized by allowing them to each have their intended impact, either in response to prior events or aimed toward those yet to take place.

Evaluating the SPIKES Model for Improving Peer-to-Peer Feedback Among Internal Medicine Residents: a Randomized Controlled Trial

BACKGROUND

Feedback improves trainee clinical performance, but the optimal way to provide it remains unclear. Peer feedback offers unique advantages but comes with significant challenges including a lack of rigorously studied methods. The SPIKES framework is a communication tool adapted from the oncology and palliative care literature for teaching trainees how to lead difficult conversations.

OBJECTIVE

To determine if a brief educational intervention focused on the SPIKES framework improves peer feedback between internal medicine trainees on inpatient medicine services as compared to usual practice.

DESIGN

Randomized, controlled trial at an academic medical center during academic year 2017-2018.

PARTICIPANTS

Seventy-five PGY1 and 49 PGY2 internal medicine trainees were enrolled. PGY2s were randomized 1:1 to the intervention or control group.

INTERVENTION

The intervention entailed a 30-min, case-based didactic on the SPIKES framework followed by a refresher email on SPIKES sent to PGY2s before each inpatient medicine rotation. PGY1s were blinded as to which PGY2s underwent the training.

MAIN MEASURES

The primary outcome was PGY1 evaluation of the extent of feedback provided by PGY2s. Secondary outcomes included PGY1 report of feedback quality and PGY2 self-report of feedback quantity and quality. Outcomes were obtained via anonymous online survey and reported using a Likert scale with a range of one to four.

KEY RESULTS

PGY1s completed 207 surveys (51% response rate) and PGY2s completed 61 surveys (42% response rate). PGY1s reported a higher extent of feedback (2.5 vs 2.2; p = 0.02; Cohen's d = 0.31), more specific feedback (2.3 vs 2.0; p < 0.01; d = 0.33), and higher satisfaction with feedback (2.6 vs 2.2; p < 0.01; d = 0.47) from intervention PGY2s. There were no significant differences in PGY2 self-reported outcomes.

CONCLUSIONS

With modest implementation requirements and notable limitations, a brief educational intervention focused on SPIKES increased PGY1 perception of the extent, specificity, and satisfaction with feedback from PGY2s.