Evaluation of feedback given to trainees in medical specialties

From Their Eyes: What Constitutes Quality Formative Written Feedback for Neurosurgery Residents

BACKGROUND

The characteristics of quality feedback from the neurosurgery resident's perspective are not fully elucidated. The Surgical Autonomy Program is an intraoperative assessment tool based on Vygotsky's Zone of Proximal Development (ZPD). SAP facilitates assessment of a resident's operative performance accompanied by written feedback.

OBJECTIVE

The goal of this study was twofold: to identify themes from the written feedback of SAP operative assessments and to examine if these themes influenced the neurosurgery residents' perception of feedback quality.

METHODS

In 2021, SAP data from 2019-2021 at two neurosurgery programs were reviewed. Feedback quality from the SAP was determined by the resident at the time of their assessment. Using a constant comparative technique, the feedback was coded using a thematic analysis. The quality of feedback within each code was analyzed.

RESULTS

There were 2968 SAP entries evaluated. When the ZPD concept was fully used, residents reported high quality feedback 91.4% of the time compared to 58.6% when ZPD was not used (p < 0.001). Qualitative analysis of the written feedback revealed five themes: Non-Specific, Specific General Observations, Key Points, Next Steps, and Independent Practice. Feedback in the Specific General Observations, Key Points, and Independent Practice categories were associated with higher level feedback than leaving the space blank (p < 0.001) or writing Non-Specific comments (p < 0.001).

CONCLUSIONS

Providing comments that discuss the resident's specific performance in the case, key learning points, or their progress towards independence, results in high quality feedback. Utilizing a theory-based tool such as the SAP can provide meaningful feedback to neurosurgical residents.

What makes giving feedback challenging? A survey of the Association Of Professors Of Dermatology (APD)

Feedback is an important aspect of resident education, so understanding the challenges that attendings face in giving feedback is important. To determine dermatology attendings' different perspectives on providing feedback to trainees and what barriers may exist in this process, an online survey study was emailed to members of the Association of Professors of Dermatology (APD) via its listserv; response was voluntary. Participants were dermatologists who are members of the Association of Professors of Dermatology. The main outcome measures were responses to survey questions that indicated comfort with feedback, perceived importance of feedback, and barriers to providing feedback. Of the 68 total survey respondents, 43(63%) were female and 25(37%) male. A majority of the attendings agreed that feedback has a positive influence on residents and improves patient outcomes. Many respondents reported giving regular feedback but a majority did not feel comfortable doing so with all residents in the program. Barriers to providing feedback included sensitivity on the part of the residents, lack of time, and fear of retaliation. When asked about ways to increase comfort, 12(17.6%) dermatology faculty noted that nothing would improve their ability to provide feedback while 28(41.2%) demonstrated interest in specialized training sessions. These results suggest that a majority of dermatology faculty face challenges in providing feedback to all of their trainees. Many would attend specialized trainings and have scheduled feedback sessions as part of the residency training to make both residents and attendings more comfortable with the whole process.

The ePortfolio in UK cardiology training: time for a new digital platform?

The UK cardiology specialist training programme utilises the National Health Service (NHS) e-Portfolio to ensure adequate progression is being made during a trainees' career. The NHS e-portfolio has been used for 15 years, but many questions remain regarding its perceived learning value and usefulness for trainees and trainers. This qualitative study in the recent pre-COVID era explored the perceived benefits of the NHS e-Portfolio with cardiology trainees and trainers in two UK training deaneries. Questionnaires were sent to 66 trainees and to 50 trainers. 50% of trainees felt that their development had benefited from use of the ePortfolio. 61% of trainees found it an effective educational tool, and 25% of trainees and 39% of trainers found the ePortfolio useful for highlighting their strengths and weaknesses. 75% of trainees viewed workplace based assessments as a means to passing the ARCP. The results show that the NHS ePortfolio and workplace based assessments were perceived negatively by some trainees and trainers alike, with many feeling that significant improvements need to be made. In light of the progress and acceptance of digital technology and communication in the current COVID-19 era, it is likely to be the time for the development of a new optimal digital training platform for cardiology trainees and trainers. The specialist societies could help develop a more speciality specific learning and development tool.

Guidance for providing effective feedback in clinical supervision in postgraduate medical education: a systematic review

The primary aim was to systematically review the empirical evidence relating to models and guidance for providing effective feedback in clinical supervision occurring in postgraduate medical education contexts. A secondary aim was to identify the common and differentiating components of models and guidance for providing effective feedback in this context. A systematic review was conducted. Fifty-one records met the inclusion criteria, including 12 empirical studies. Empirical records meeting inclusion criteria were critically appraised. Qualitative content analysis was applied to the guidance on effective and ineffective feedback provision to identify key principles. A composite model was created synthesising the guidance identified for providing effective feedback. The evidence supporting specific models and guidance in postgraduate medical education was limited. However, there is evidence to support all of the commonly identified principles. In addition, a consensus about the principles of effective feedback in clinical supervision in postgraduate medical education was found.

Watching the watchmen: an evaluation of educational supervision in a busy district general hospital

Introduction

Educational supervisors (ESs) play a critical role in the training of Foundation doctors. Many hospital trusts do not currently offer formal mechanisms to ensure the quality of supervision is at a high standard. Our Trust wanted to empower trainees to offer objective feedback on the quality of the supervisors.

Methods

We introduced a feedback form sent to all Foundation doctors at our Trust. The questionnaire was designed to identify whether ESs were meeting their responsibilities as defined by the Health Education England South West’s Severn Deanery. We collected data throughout the academic year 2017–2018 (Year 1) as a pilot, before rolling out the definitive questionnaire with minor modifications from 2018 to 2019 (Year 2).

Results

All respondents met with their supervisor within the first month of the placement and 90.7% of the trainees found it easy to meet with their supervisor. The Trust received generally very good feedback for all of its supervisors. Low numbers (4/120 trainees) reported supervisors not engaging with the exception reporting process.

Conclusion

Our Trust provides ESs of a high standard. The authors believe collecting feedback for ESs will achieve three things: 1) Drive up standards through increasing accountability of ESs receiving objective feedback. This will be of critical importance in the context of the severe acute respiratory syndrome coronavirus 2 pandemic and the changes to our work it has necessitated. 2) Empower trainees to make informed decisions about where they wish to train and under which supervisors. 3) Facilitate revalidation and appraisal for supervisors by collecting data from trainees on the quality of their supervision.

Development of a GMC aligned curriculum for internal medicine including a qualitative study of the acceptability of 'capabilities in practice' as a curriculum model

The Shape of Training review and the General Medical Council (GMC) requirements in demonstrating generic professional capabilities were major drivers for the Joint Royal Colleges of Physicians Training Board (JRCPTB) to develop the new internal medicine curriculum. In particular, the GMC required progression to a more outcomes-based curriculum. The present curricula for physician training are based on demonstrating a large number of individual competencies that are assessed by a variety of different methods. It was felt that current system was overwhelming and had become a 'tick box' exercise. The new curriculum is based on a much smaller number of outcomes, called capabilities in practice, which reflect the key professional work activities of a fully trained physician. The aim is to re-emphasise the role of professional judgement in 'trusting' the work a trainee does and thus make assessment more realistic and meaningful for both trainees and trainers. The proof of concept study explored the feasibility of using this outcomes-based model of assessment in a UK NHS setting. The learning from the study has enabled us to make significant changes to the internal medicine curriculum. The GMC has recently approved the curriculum and the JRCPTB is implementing the programme from August 2019.

Higher medical training in Rheumatology in the UK: any lessons worth learning?

Across Europe, provision of high quality care for people with rheumatological conditions is at least partly dependent upon the rheumatologist, who generally plays a key role in making a diagnosis and in co-ordinating a patient’s care. In addition, in many countries the rheumatologist is pivotal in lobbying for services for patients with these disorders. It therefore follows that the training and accreditation of rheumatologists is important in ensuring high quality healthcare. In this commentary, I appraise some developments in the training of rheumatologists in the UK (training which has changed markedly over the past two decades). I do this as a means of promoting discussion.