Abstract
BackgroundConsistent formative feedback is cornerstone to competency-by-design programs and evidence-based approaches to teaching and learning processes. There has been no published research investigating feedback from residents’ perspectives. We explored the value residents place on feedback in routine operating room settings, their experiences, and understanding of the role of feedback in their training and developing professional identity.MethodsInterpretive phenomenological analysis of residents’ experiences with feedback received in clinical settings involved two focus groups with 14 anesthesia residents at two time points. Analysis was completed in the context of a teaching hospital adapting to new practices to align with nationally mandated clinical competencies. Focus group conversations were transcribed and interpreted through the lens of a social constructivist approach to learning as a dynamic inter- and intra-personal process, and evidence-based assessment standards set by the International Test Commission (ITC).ResultsResidents described high quality feedback as consistent, effortful, understanding of residents’ thought processes, and containing actionable advice for improvement. These qualities of effective evaluation were equally imperative for informal and formal evaluations. Residents commented that highest quality feedback was received informally, and formal evaluations often lacked what they needed for their professional development.ConclusionResidents have a deep sense of what promotes their learning. Structured feedback tools were seen positively, although the most important determinants of their impact were faculty feedback- and broader evaluation-skills and motivations for both formal and informal feedback loops.
Highlights
Consistent formative feedback is cornerstone to competency-by-design programs and evidencebased approaches to teaching and learning processes
Participants were supported to make the implicit nuances of their personal experiences explicit through peerconversation that unfolded in the focus group sessions
All themes but those specific to structured feedback tools were identified from analysis of the first round of focus groups
Summary
Consistent formative feedback is cornerstone to competency-by-design programs and evidencebased approaches to teaching and learning processes. CBME has adopted a milestone oriented assessment structure that involves a clear learning path, frequent observations in practice settings, meaningful feedback, time and opportunity to develop new skills, and committee assessment of readiness to iteratively progress and professionally practice at appropriate levels [2] This renewed language around resident learning and assessment gives residency training programs the opportunity to reflect on and adapt current practices in support of optimal resident learning. These decisions are likely to be better, or better founded, than the decisions they would have made in the absence of elicited evidence [4] This formative and situated approach to evaluation results in feedback that is categorically different from global rating scales of overall quality (generalized assessments often benchmarked in comparison to others being evaluated or to raise red flags for needed intervention) and summative evaluation (an evaluation of achieved knowledge and skills in a specific area as an end-point to demonstrate academic or clinical qualification at one point in time)
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