Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Acad Emerg Med. 2009 Dec;16 Suppl 2:S76-81. doi: 10.1111/j.1553-2712.2009.00592.x.
Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED.
This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses.
Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001).
Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED.
有效的反馈对于医学教育至关重要。我们对急诊医学（EM）主治医生和住院医师对反馈的看法知之甚少。本研究的重点是研究主治医生在急诊部（ED）临床环境中给住院医师的教育反馈的看法。作者比较了主治医生和住院医师对实时反馈的满意度，并假设这两个群体对他们目前在 ED 中提供和接收的反馈的总体满意度会有不同的报告。
本观察性研究通过网络调查了 17 个急诊住院医师培训项目的主治医生和住院医师。主要结果是 ED 中反馈的总体满意度，评分范围为 10 分。其他调查项目涉及反馈的具体方面。使用线性广义估计方程（GEE）模型比较总体满意度，使用二项 GEE 模型比较二项反应，使用有序逻辑 GEE 模型比较有序反应。
373 名主治医生（71%）和 356 名住院医师（60%）完成了调查。主治医生对整体反馈（平均得分 5.97 分与 5.29 分，p<0.001）和反馈的及时性（比值比[OR] = 1.56，95%置信区间[CI] = 1.23 至 2.00；p<0.001）的满意度均高于住院医师。主治医生还更有可能将积极反馈、建设性反馈、程序反馈、文件记录、ED 流程管理和循证决策的反馈质量评为非常好或优秀。主治医生报告时间限制是提供反馈的最大障碍，并且比住院医师更有可能报告反馈通常由主治医生发起（OR = 7.09，95%CI = 3.53 至 14.31；p<0.001）。
主治医生对所提供反馈的质量、及时性和频率的满意度高于住院医师对所收到反馈的满意度。主治医生和住院医师对谁发起反馈以及提供有效反馈所需的时间有不同的看法。了解这些反馈看法上的差异，可能有助于指导未来的教育工作，以改善 ED 中的反馈。
