Karim Azad S, Sternbach Joel M, Bender Edward M, Zwischenberger Joseph B, Meyerson Shari L
Department of Surgery, Northwestern University, Chicago, Illinois.
Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
J Surg Educ. 2017 Nov-Dec;74(6):e81-e87. doi: 10.1016/j.jsurg.2017.10.001.
Residents frequently report inadequate feedback both in quantity and quality. The study evaluates the quality of faculty feedback about operative performance given using an app-based system.
Residents requested operative performance evaluation from faculty on a real-time basis using the "Zwisch Me!!" mobile application which allows faculty to provide brief written feedback. Qualitative analysis of feedback was performed using grounded theory.
The 7 academic medical centers with thoracic surgery training programs.
Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty.
Residents (n = 33) at 7 institutions submitted a total of 596 evaluations to faculty (n = 48). Faculty acknowledged the evaluation request in 476 cases (80%) and in 350 cases (74%) provided written feedback. Initial open coding generated 12 categories of feedback type. We identified 3 overarching themes. The first theme was the tone of the feedback. Encouraging elements were identified in 162 comments (46%) and corrective elements in 230 (65%). The second theme was the topic of the feedback. Surgical technique was the most common category at 148 comments (42.2%) followed by preparation for case (n = 69, 19.7%). The final theme was the specificity of the feedback. Just over half of comments (n = 190, 54.3%) contained specific feedback, which could be applied to future cases. However, 51 comments (14.6%) contained no useful information for the learners.
An app-based system resulted in thoracic surgery residents receiving identifiable feedback in a high proportion of cases. In over half of comments the feedback was specific enough to allow improvement. Feedback was better quality when addressing error prevention and surgical technique but was less useful when addressing communication, flow of the case, and assisting. Faculty development around feedback should focus on making feedback specific and actionable, avoiding case descriptions, or simple platitudes.
住院医师经常反映所获得的反馈在数量和质量上都不足。本研究评估了使用基于应用程序的系统给出的关于手术操作表现的教员反馈的质量。
住院医师使用“Zwisch Me!!”移动应用程序实时向教员请求手术操作表现评估，该应用程序允许教员提供简短的书面反馈。使用扎根理论对反馈进行定性分析。
7个设有胸外科培训项目的学术医疗中心。
综合培训和传统培训途径的志愿胸外科住院医师及其附属心胸外科教员。
7家机构的住院医师（n = 33）共向教员（n = 48）提交了596份评估。教员在476例（80%）中确认了评估请求，在350例（74%）中提供了书面反馈。初始开放式编码产生了12类反馈类型。我们确定了3个总体主题。第一个主题是反馈的语气。在162条评论（46%）中发现了鼓励性内容，在230条评论（65%）中发现了纠正性内容。第二个主题是反馈的主题。手术技术是最常见的类别，有148条评论（42.2%），其次是病例准备（n = 69，19.7%）。最后一个主题是反馈的具体性。略多于一半的评论（n = 190，54.3%）包含可应用于未来病例的具体反馈。然而，51条评论（14.6%）对学习者没有有用信息。
基于应用程序的系统使胸外科住院医师在很大比例的病例中获得了可识别的反馈。超过一半的评论中反馈足够具体，可促进改进。在针对错误预防和手术技术时，反馈质量更好，但在涉及沟通、病例流程和协助方面时，用处较小。围绕反馈的教员培训应侧重于使反馈具体且可操作，避免病例描述或简单的陈词滥调。
