Prospective Controlled Assessment of Impact of Feedback on Gastroenterology Trainees in Outpatient Practice

Abstract

Previous studies have demonstrated the value of systematic feedback in enhancing endoscopic procedure performance. It remains unknown whether feedback may play a role in modifying physician performance in outpatient practice. This study aimed to assess the impact of systematic feedback on duration of office visits of gastroenterology (GI) trainees in outpatient practice. Patients attending a GI outpatient department in an academic medical center were prospectively followed over 4months. The duration of office visits for consecutive patients seen by five GI fellows of similar experience level were recorded for 2months (pre-feedback); confidential feedback was then provided to each fellow on a weekly basis for 2months detailing their individual consultation times and the comparative, anonymous times of the other fellows (post-feedback). Over the course of the study, 1,647 outpatients were seen by five GI fellows. Pre-feedback consultation durations differed significantly with one fellow taking 2.5 times longer than their colleague. Following feedback, times shortened significantly for all fellows, with the greatest impact observed in those trainees taking longer at baseline. There were no significant differences in satisfaction levels among patients seen by each trainee. There was a wide disparity in the consultation times among GI fellows. Systematic feedback shortened times among all trainees and enhanced uniformity by having the greatest impact among those fellows taking longer at baseline. Routine provision of feedback may be valuable in enhancing uniformity of outpatient practice although clinicians should ensure that shortening consultation visits does not compromise quality of patient care. Future larger studies of feedback in this setting will be enhanced by incorporating objective measures of quality of care and patient satisfaction.