Article review: Feedback in the Emergency Department

Feedback is important in teaching and learning.

I am constantly surprised by medical student and resident comments that they rarely receive feedback. In contrast, seemingly on every shift, I hear faculty giving little nuggets of feedback - during the oral presentation, during the resuscitation, after a difficult interaction, etc. There must be some disconnect.

This multi-institutional, survey-based, observational study at 17 EM residency programs asked attending physicians and residents about feedback in the ED. The primary outcome measure was overall satisfaction with feedback.

Results
The response rate was 71% for attendings (373/525) and 60% for residents (356/596). Side note: Survey studies are generally inconclusive if response rates are <70%.

There was a statistically significant difference between the feedback satisfaction scores (on scale of 1-10 with 10 being highest satisfaction).

• Attending physicians: 5.97
• Resident physicians: 5.29

Furthermore, when evaluating the quality of different aspects of feedback delivery, there were statistically significant differences in the satisfaction ratings between the attendings and residents. Overall, attendings felt more satisfied with feedback delivery on various topics than residents were.

• Quality of positive feedback (50% attendings, 36% residents)
• " of constructive feedback (29% attendings, 22% residents)
• " of feedback re: procedural skills (48% attendings, 34% residents)
• " of documentation (36% attendings, 28% residents)
• " of ED flow management (29% attendings, 21% residents)
• " of evidence-based decision making (28% attendings, 18% residents)
  

What is more interesting to me is the discrepancy between what the attendings and residents perceived in frequency of feedback. Specifically, 42% of attendings stated that feedback delivery was being done on every shift. Contrast this to only 7% of residents who felt the same. Why the disconnect? Is it purely misperception?

In re-reading this article, I wonder how this question was phrased though. Was it indeed perception or fact?

Let's say there are usually 5 residents per attending shift, and the attending gives feedback every shift to at least 1 person. When surveyed, the attending would answer - "Yes, I give daily feedback". In contrast, because there are multiple learners, residents may not have received daily feedback. By law of averages, residents would have received feedback every 5 shifts.

The data showing that 42% of attendings and 7% of residents were involved in feedback delivery every shift may actually be true (rather than pure perception). This illustrates the trickiness of designing and writing surveys.

Bottom Line
We should be working to improve positive and constructive feedback delivery in the Emergency Department, despite the various obstacles.

Reference
Yarris L, et al. Attending and resident satisfaction with feedback in the emergency department. Acad Emerg Med. 2009; 16:S76–S8.

Also see previous post on Failing at Feedback in Medical Education.