Understanding the Role for Operative Performance Rating Tools in Meeting Surgical Trainee Feedback Needs: A Qualitative Study

Abstract

INTRODUCTION Performance feedback on operative skills is an essential component of surgical training, potentially impacting trainee attitudes, skill acquisition, and competence.1 Additionally, feedback may positively impact patient outcomes.2 However, providing effective feedback in today’s dynamic healthcare environment has become increasingly challenging, given increasing patient demands, pressures for cost containment, and reduced trainee duty hours.1 Understanding the complex feedback environment from trainees’ point of view may help overcome barriers in the feedback experience and optimize its benefits.3 This study aimed to understand surgical trainees’ views on their operative performance feedback needs and the extent to which performance rating tools can help meet those needs. METHODS A research fellow trained in qualitative methods conducted semistructured interviews with surgical trainees. Participants included residents and clinical fellows in general surgery and plastic and reconstructive surgery at Johns Hopkins and 4 other institutions. Recruitment and question order were informed by emerging data from previous interviews. Thematic analysis was performed on recurring themes generated during interviews. The Johns Hopkins Institutional Review Board acknowledged this study as exempt from review. RESULTS We conducted 20 interviews: 8 junior residents, 8 senior residents, and 4 clinical fellows. Fifteen participants were in plastic surgery (75%); 5 were in general surgery; and 18 were men (90%). Seventeen participants (85%) reported that feedback was very or extremely important in their surgical training. All trainees (100%) stated that verbal, face-to-face feedback is the most valuable type of feedback, especially if occurring during (94%) or immediately after (44%) cases. Timeliness greatly influences feedback value because it is still useful for trainees if it is received within 1 week of the event, improving event recall and making feedback more actionable. This was of interest to trainees who seek to improve within the rotation. Trainees defined good feedback as that which is “objective, current, evaluative, formative, accurate and not easily dismissible as just an opinion.” They preferred actionable recommendations in the format of “what you did well…,” “what you did wrong…,” and “what you can do to improve…” When asked about the role of performance rating tools in feedback, 6 trainees viewed these tools as potentially useful adjuncts if they did not replace face-to-face feedback. Seven trainees stated that performance rating tools can prompt face-to-face feedback if the evaluator is committed to the feedback process. Three residents acknowledged performance rating tools as an opportunity for benchmarking among peers. Main barriers to assessment tool completion include increased administrative burden (ie, “1 more thing”) and scores too simplistic to provide meaningful feedback (ie, “just a number”). CONCLUSIONS Verbal, face-to-face feedback is very or extremely important to surgical trainees. Ideally, feedback would be given during or immediately after cases and is still valuable if given within 1 week of the event. Performance rating tools can be useful aids for providing feedback, but they should not replace face-to-face interactions. Assessment tools that can be used to increase the frequency and quality of feedback may help accelerate trainee skill acquisition, potentially improving the quality and efficiency of surgical training.