Trainees Deserve Better Feedback

Feedback plays a key role in medical edu-cation and faculty development as it allows everyone to evaluate their performance and improve their intrapersonal skills.^1,2 To be effective, feedback must be timely, specific, constructive, actionable, linked to goals, nonjudgmental, and easy to under-stand. Feedback is often omitted or im-properly provided during medical training. Some of the barriers to effective feedback are lack of consistency, of time, and of comfort.^1-5 The ideal feedback model has not been defined, and the impact of feed-back during hematology-oncology training has not been studied in depth.

To improve the quality of feedback in the hematology-oncology fellow-ship program at MedStar Washington Hospital Center, we surveyed 7 fellows and 15 faculty members. Their answers to Likert scale and open-ended questions identified 2 barriers to effective feedback: discomfort and lack of protected time. In collaboration with the American Society of Clinical Oncology (ASCO) Quality Training Program, we developed three 2-hour virtual workshops that covered the following, among other topics:

1. Establishing the appropriate environ-ment for feedback
2. Giving nonjudgmental feedback (low-interference observations)
3. Having ongoing conversations/dialogs to provide real-time feedback
4. Creating a structured approach for reinforcing feedback

First, we discussed the topics as a group and then in 2 breakout sessions. We also set up a weekly 30-minute protected feedback time for faculty and fellows, which was integrated into the educational calendar via automated reminders.

We surveyed attendees 1 month and 3 months after the workshops. Eleven of the 15 faculty members completed the questionnaires. At baseline, 81.8% had reported that they did not have protected time to complete evalua-tions.6 This percentage decreased to 63.6% immediately after the workshops and to 27.3% at the 3-month follow-up.⁷ Similarly, only 65.5% of participants said they felt comfortable giving feedback before attending the workshops, but 81.8% said they did feel comfortable immediately after the workshop, and 81.1% still felt that way 3 months later.

At baseline, half the fellows said they were receiving nonactionable feedback, but only 10% of them said that after the workshops. Most participants said that the workshop had addressed barriers to high-quality feedback. Overall, fellows reported that they had received feedback primarily on note-taking presentations, and inter-personal skills, whereas faculty reported that they had received feedback about time management and patient care. Trainees also reported an objective improvement in the quality and frequency of feedback after the workshops.

This pilot QI study helped address a major barrier to improvement and growth in our training program and confirmed that feedback skills must be taught and practiced. Three virtual workshops showed tangible results in terms of satisfac-tion with and quality of feedback among faculty and fellows.

Our results are salient because the survey at 3 months after intervention confirmed sustainability. Its limita-tions include small size and single-institution design.

Our future goals include developing and incorporating a formal curriculum for our training program and maintaining the weekly protected time for feedback to ensure the results remain sustainable and reproducible with incoming fellows. In the future, we could implement similar studies in other institutions.

References

1. Carr BM, O’Neil A, Lohse C, et al. Bridging the gap to effective feedback in residency training: perceptions of trainees and teachers. BMC Med Educ. 2018;18(1):225. doi:10.1186/s12909-018-1333-9
2. Ende J. Feedback in clinical medical education. JAMA. 1983;250(6):777-781. doi:10.1001/jama.1983.03340060055026
3. Lefroy J, Watling C, Teunissen PW, et al. Guidelines: the do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ. 2015;4(6):284-299. doi:10.1007/s40037-015-0231-7
4. Anderson PA. Giving feedback on clinical skills: are we starving our young? J Grad Med Educ. 2012;4(2):154-158. doi:10.4300/JGME-D-11-000295.1
5. Anderson L, Silet K, Fleming M. Evaluating and giving feedback to mentors: new evidence-based approaches. Clin Transl Sci. 2012;5(1):71-77. doi:10.1111/j.1752-8062.2011.00361.x
6. Schlam I, Sewaralthahab S, Peravali M, et al. Improving feedback for hematologists and oncologists in training. J Clin Oncol. 2021;39(15_suppl):11025. doi:10.1200/JCO.2021.39.15_suppl.11025
7. lthahab SS, Peravali M, Schlam I, et al. Improving feedback for hematology and oncology fellows via virtual workshops: sustainability analysis. Blood. 2021;138(suppl 1):1895. doi:10.1182/blood-2021-153303