Differences in faculty feedback for high, expected, and below‐expected clinically performing emergency medicine residents

Abstract

Objectives A lifelong pursuit such as medicine is frequently paired with a framework of “deliberate practice” for improvement. It is unclear whether the quality of feedback varies across different learner levels. Our study aims to assess whether a difference exists in the quality of feedback delivered to high‐, expected‐, and below‐expected performer emergency medicine (EM) residents based on their attending‐identified performance level. Methods We conducted a retrospective review of written EM resident feedback collected between November 2018 and March 2021. Clinical performance level was subjectively determined by attending faculty in their feedback. Feedback was coded on a scale from 0–5 based on the presence (1) or absence (0) of the items modified from the Ende's SMART criteria: Specific (S), Measurable (M), Achievable (A), Relevant (R), and Time‐bound (T). The primary outcome was any total modified SMART criteria score difference concerning performance level using logistic regression with Generalized Estimating Equations (GEE). Secondary outcomes were differences for individual criteria. Results We analyzed 1284 evaluations (311 high performers, 930 expected performers, and 43 below‐expected performers) of 94 unique residents from 66 different evaluators. Mean total modified SMART scores were significantly higher in high and below‐expected performers than those designated as expected performers by faculty evaluators. Achievable and Relevant written feedback was provided to high performers in a significantly larger proportion than expected and below‐expected performers. Only 278 out of 1284 evaluations met criteria for Specific. Conclusions Mean total modified SMART feedback scores were significantly greater in high performers and below‐expected performers when compared to expected performers. Achievable and Relevant feedback was provided in greater proportions to high performer residents compared to expected and below‐expected performers. These findings are a challenge to academic faculty to engage in quality feedback delivery for residents at all performance levels.

Trends in nursing feedback for emergency medicine residents: A mixed‐methods survey analysis of national practices

“…Concerns regarding retributive feedback related to interpersonal dynamics were highlighted in multiple free‐text responses. Gender‐disparate assessment, a well‐described phenomenon whereby female residents receive more negative evaluations than their male counterparts, 17,20–22 were cited both as reasons some programs do not employ nursing assessments and as a concern among those that do. If such feedback is to be considered reflective of residents' true competencies, programs may consider implementing (or intensifying) implicit bias training, including targeted training, and editing, redacting, or contextualizing gender‐specific feedback prior to communicating it to trainees.…”

“…19 Concerns regarding retributive feedback related to interpersonal dynamics were highlighted in multiple free-text responses. Genderdisparate assessment, a well-described phenomenon whereby female residents receive more negative evaluations than their male counterparts, 17,[20][21][22] were cited both as reasons some programs TA B L E 3 Inductive core themes and subthemes with excerpts from responses to "please outline the reasons for why you do not currently collect nursing feedback on resident performance?"…”