Factors influencing the effectiveness of multisource feedback in improving the professional practice of medical doctors: a systematic review

Abstract

BackgroundMultisource feedback (MSF) is currently being introduced in the UK as part of a cycle of performance review for doctors. However, although it is suggested that the provision of feedback can lead to a positive change in performance and learning for medical professionals, the evidence supporting these assumptions is unclear. The aim of this review, therefore, was to identify the key factors that influence the effectiveness of multisource feedback in improving the professional practice of medical doctors.MethodRelevant electronic bibliographic databases were searched for studies that aimed to assess the impact of MSF on professional practice. Two reviewers independently selected and quality assessed the studies and abstracted data regarding study design, setting, MSF instrument, behaviour changes identified and influencing factors using a standard data extraction form.ResultsA total of 16 studies met the inclusion criteria and quality assessment criteria. While seven studies reported only a general change in professional practice, a further seven studies identified specific changes in behaviour. The main professional behaviours that were found to be influenced by the feedback were communication, both with colleagues and patients and an improvement in clinical competence/skills. The main factors found to influence the acceptance and use of MSF were the format of the feedback, specifically in terms of whether it was facilitated, or if narrative comments were included in the review, and if the feedback was from sources that the physician believed to be knowledgeable and credible.ConclusionsWhile there is limited evidence suggesting that MSF can influence professional performance, the quality of this evidence is variable. Further research is necessary to establish how this type of feedback actually influences behaviours and what factors have greatest influence.

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

“…22 The impact of physician feedback has been correlated with the knowledge and credibility of the person who provides the feedback. 23 We observed a further reduction of cranial CT rates temporally related to providers receiving annual CT reports delivered by the ED division chief. The primary impact was to reduce variability in CT rates between ED providers.…”

The impact of multisource feedback (MSF) including patient feedback on psychiatric trainees

“…Intention to change cannot be proven to result in actual change (Webb & Sheeran, 2006) and it could be argued that healthcare systems are more concerned with behaviour change resulting in better patient care than intention to improve or self-reported improvements. However measuring impact on patient care in this area is difficult and health psychology theories such as theory of planned behaviour (Ajzen & Madden, 1986) and protection motivation theory (Rogers, 1985) assume intentions cause behaviour (Ferguson, Wakeling & Bowie, 2014).…”

“…For example, facilitation of feedback in order to promote effective reflection (Overeem et al, 2009b).The reflection literature proposes that reflection is a key step in integrating new information and learning (Moon, 2004). It also appears important to consider MSF tools carefully in order to gain maximum benefit; including having enough participants (Lelliott et al, 2008), multiple perspectives (Ferguson, Wakeling & Bowie, 2014;Overeem et al, 2010), patients Sargeant, Mann & Ferrier, 2005;Sargeant et al, 2007) and free text (Ferguson, Wakeling & Bowie, 2014;Overeem et al, 2010). It would also be pertinent to educate those asked to complete MSF feedback (Canavan et al, 2010;Saedon, Saedon & Aggarwal, 2010), as feedback is generally shown to be a positive force for learning over time , but needs to be specific, constructive and useful (Ferguson, Wakeling & Bowie, 2014;Overeem et al, 2009b;Sargeant, Mann & Ferrier, 2005;Sargeant et al, 2007).…”

“…Evidence was critically appraised and the outcome evaluated using the Barr adaption of Kirkpatrick evaluation model applied to the results (Barr et al, 2000), modified by Ferguson and Overeem (Ferguson, Wakeling & Bowie, 2014;Overeem et al, 2010) (Barr et al, 2000;Ferguson, Wakeling & Bowie, 2014;Overeem et al, 2010) Study quality assessment: I used the quality criteria developed by Buckley (Buckley et al, 2009), used in earlier systematic reviews (Ferguson, Wakeling & Bowie, 2014;Miller & Archer, 2010)- Figure 2. These consist of 11 'quality indicators' with higher quality studies meeting at least 7 of these indicators.…”

“…There is some assessing its educational effects, including a systematic review (Reinders M et al, 2011) and other studies (Greco, Brownlea & McGovern, 2001;Patel et al, 2011), finding beneficial effects of patient feedback, although usually at lower Kirkpatrick levels (Barr et al, 2000). The strongest evidence for WPBA fuelled improvement in medical performance comes from systematic reviews by Miller (Miller & Archer, 2010), and later Ferguson (Ferguson, Wakeling & Bowie, 2014). Miller studies several WPBA and states that MSF seems the most likely to fuel practice improvement, however acknowledges problems with methodological rigour, conflicting results and confounding factors of studies.…”