P4A155: Improving the Quality, Timeliness, Perception of Resident Feedback Through Structured Conversations

Background: Engaging in meaningful feedback both as the deliverer and recipient is a cornerstone of residency training. In residency, meaningful feedback influences the growth of trainee physicians and ultimately influences patient care; however, there is significant variability in the quality of feedback received by medical learners due to variable skill and comfort level in feedback givers. The annual program survey for the University of Illinois College of Medicine Pediatric residency program demonstrated that standardized and quality feedback is a key area for improvement. Commonly identified barriers for feedback conversations include time, likeability, confidence and a mismatch in perception of amount of feedback received versus given. The purpose of this study was to develop a simplified standardized feedback approach to both increase resident satisfaction with the amount and quality of specific, actionable and timely feedback received while also improving the perceived competency and comfort of attendings in crafting and delivering feedback.

Methods: Pediatric and Med-Peds residents completed pre-surveys to rate the quality and timeliness of the feedback they received on inpatient pediatric floors. Faculty completed pre-surveys to rate the quantity of feedback they provided and their comfort with delivering feedback. Attendings then participated in a faculty development workshop on how to improve the delivery of quality and timely feedback. The Pediatric Department then implemented this standardized feedback approach consisting of short feedback conversations about 2-3 times per week (goal setting, check in and follow up). Faculty and residents then completed weekly post-implementation surveys.

Results: Resident pre-surveys conveyed that the majority of residents (76%) received feedback only once or twice a week. Only 6% of residents reported receiving feedback 3-4 times a week. After implementation, feedback was given more frequently with more than half (54%) of residents receiving feedback 3-4 times a week. This represented a significant improvement (p < 0.001). When rating the quality and usefulness of feedback, 89% of residents rated their feedback as “good or excellent” post-implementation compared to 48% pre-implementation (p < 0.001). Furthermore, satisfaction with the feedback conversations doubled among residents and attendings with this new approach. Pre-surveys showed only 45% of residents and 44% of attendings, respectively, rating the feedback experience as “satisfactory or highly satisfactory.” Post-implementation, 92% of both residents and attendings rated their experience as “satisfactory or highly satisfactory,” again representing a significant improvement (p < 0.001).

Conclusion: This new approach to resident feedback offers an alternative to “Feedback Fridays” and addresses many of the reported barriers to effective feedback conversations of time constraints and discomfort. Short feedback conversations throughout the week enabled residents to do some course correction, allowing them to demonstrate growth throughout the week with the same attending. Additionally, this structure provides more opportunities for identification of personalized rather than general goals and more self-reflection.