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Objectives: Performance feedback is not always well utilized in healthcare. To more effectively incorporate it, we used a discussion of current feedback systems to explore paramedics' perceived needs regarding feedback and to understand what feedback would improve their performance as healthcare providers. Methods:We used a qualitative methodology with semistructured interviews of paramedics to explore perceptions and desires for feedback. Interpretive descriptive analysis was performed with continuous recruitment until thematic saturation was achieved. Themes were identified and a coding system was developed by two investigators separately and merged by consensus. The analysis was audited by a third investigator, and a member check was performed.Results: Many different ideas were discussed that were analyzed to develop several major recurrent themes.One such theme was positive perception of feedback by paramedics. Despite the positive perceptions discussed, the shortcomings of current systems were also frequently discussed as were perceived barriers to receiving meaningful feedback. The idea of following up on patients' courses/outcomes also arose frequently during the interviews. In addition, feedback and its interaction with mental health emerged as a theme in terms of its potential for both positive and negative impact. Finally, suggestions about the future were also common with paramedics providing thoughts regarding what future systems could be developed or what changes could be made to provide them with meaningful feedback. Conclusions:Our findings show how paramedics perceive feedback, but still note how barriers may impair its uptake and how it may affect their mental health. Our participants also made recommendations about what they would want to see in future feedback systems. This information can provide the foundation to improve current feedback systems or structure new ones to allow paramedics to continue to develop themselves as healthcare professionals.P erformance feedback on medical care and outcomes in prehospital care is generally infrequent and inconsistently delivered. 1 Research has also produced unreliable results regarding the value of feedback to health professionals-potentially reflecting the variation in content of feedback, the context of the feedback, and the mode of delivery. [2][3][4][5] This suggests that not all feedback is equal: not all feedback systems achieve their intended end of prompting performance improvement. 6,7 Some may point out systems-level changes (e.g., process improvement), 3 while others may not provide enough meaningful information to

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Background: Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives: We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool.

Introduction: Clinical performance feedback is not always well utilized in healthcare, despite its potential in continual professional development to improve provider performance in healthcare settings. In order to more effectively incorporate performance feedback, we must evaluate the strengths and flaws of current feedback systems and determine best practices. With this goal, we sought to explore the perspectives of paramedics on the feedback they want and what they currently receive. Methods: We used a qualitative methodology with semi-structured interviews. A convenience sampling of practicing paramedics in the Niagara region was interviewed. We used an interpretive descriptive technique with continuous recruitment of participants until thematic saturation was achieved. Themes were identified and a coding system was developed by two investigators separately to code themes and sub-themes. These two systems were merged by consensus. We conducted a member check by contacting participants to determine if they agreed with our analysis. Results: 12 paramedics were interviewed. In our analysis we found several themes: positive perception/aspects of feedback and current feedback systems, current barriers, shortcomings of current systems, desire to know patient outcomes, and mental health as it relates to feedback. Positive perception of feedback has included asking for feedback, specific requests for feedback and strengths of current systems. Perceived barriers to feedback included issues around: confidentiality, practical limitations and social barriers. The limitations of current feedback systems noted the lack of feedback, and the questionable value of the feedback received. The desire to know patients’ clinical course/outcomes was also a recurrent theme, with paramedics spontaneously expressing desire for feedback specific to cases, greater insight into the ultimate diagnosis and knowledge of outcomes. The mental health of paramedics was frequently discussed as well, including positive impact on job satisfaction and confidence and potential for negative impact. Conclusion: We have explored and generated a description of the perspectives of paramedics on feedback in general and the clinical performance feedback they currently receive. The information gained will lay the groundwork for improved feedback systems to provide paramedics with the feedback they want to continually improve as healthcare providers.