Resident Perspective on Feedback and Barriers for Use as an Educational Tool

Abstract

Background Feedback in physician graduate medical education is not clearly defined. Some parties may view questioning as a form of feedback, others the conversations over lunch, some the comments in the operating room (OR), and still others the written evaluation at planned meetings. The lack of clarity in defining what constitutes feedback is concerning when this is considered a fundamental means of education to enhance practices and care for patients. If residents do not recognize they are receiving feedback, or the response to feedback is met with opposition, then feedback as an educational device can be limited. For this manuscript, feedback is defined as written or verbal comments regarding medical knowledge, performance, technique, or patient care. Objective This study attempts to identify barriers to feedback by identifying attitudes toward feedback processes through a questionnaire. Methods Ten questions were provided to residents at a single institution representing, emergency medicine, family medicine, internal medicine, neurology, and neurosurgery during the 2017-2018 academic year. Response was voluntary and the study was granted exemption by local institutional review board since no identifying information was collected to link responses to specific residents. Questions were formulated to identify how positive or negative a resident felt toward specific aspects of feedback. Results Of the possible 84 resident respondents, 40 residents participated reflecting a response of approximately 48%. Questionnaires revealed that 22.5% of respondents found feedback to be a stressful event. Sixty-seven point five percent (67.5%) of resident respondents associated the prompt that they are about to receive feedback as concerning. Only 2.5% of residents identified a meeting with the program director as a sign that the resident may be doing well. Appointments for feedback were viewed as a positive event in 12.5% of respondents. Ninety-five percent (95%) of residents do not feel that all feedback will affect their permanent record. Ten percent (10%) of residents identified receiving feedback as a positive event. Ninety-five percent (95%) of residents indicated that they have actively tried to change behavior or practices based on feedback. Forty percent (40%) of residents found themselves censoring "negative" feedback. Conclusions Barriers to feedback include the inability to present sensitive subjects in a constructive manner and superficial relationships between the evaluator and resident physician. Research directed at addressing these barriers could lead to improved use of feedback as an educational tool.

Keywords: education; feedback; residency.

Figure 1. Resident Attitudes Toward Various Aspects of Feedback

Average resident response to questionnaire. Zero indicates a neutral position regarding corresponding question, -1 indicates a negative position, and +1 indicates a positive position. Note: censoring “negative” comments was scored as -1 and lack of censoring was scored as +1. Error bars indicate 95% confidence interval.