D. Saddawi-Konefka is assistant professor of anesthesia, Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
A. Sullivan is associate professor of medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Acad Med. 2021 Oct 1;96(10):1425-1430. doi: 10.1097/ACM.0000000000004046.
Written feedback is often overly positive, nonspecific, and difficult to interpret. Learner satisfaction with written feedback is low and obtaining written feedback that encourages self-reflection is challenging. Improving feedback quality is laborious and only modestly effective.
The authors developed the LEAF (Learner-Engaged Analysis of Feedback) method to improve learner satisfaction with, and reflection on, existing written feedback. The method pairs a learner and coach to methodically identify themes in the learner's written feedback. Themes occurring more frequently or less frequently than typical offer areas for reflection, as they may identify learners' relative strengths or weaknesses. The method was introduced at the Massachusetts General Hospital in 2017 during program director (PD) meetings with anesthesiology residents. In 2018, resident satisfaction was measured (1 to 5 Likert-type questions, 1 = "not at all satisfied," 5 = "extremely satisfied") for 4 feedback sources, 2 related to the LEAF method (PD meetings, written feedback) and 2 unrelated (verbal feedback, mentor feedback). Residents' comments were qualitatively assessed to explore the impact on self-reflection.
Residents who had participated in a LEAF session (n = 54), compared with those who had not (n = 11), reported higher satisfaction with written feedback (mean 3.1 versus 2.5, d = 0.53, P = .03) and PD meeting feedback (mean 3.8 versus 2.8, d = 0.80, P = .03). There were no significant differences between groups for satisfaction with feedback unrelated to the LEAF method. Qualitative analysis of comments suggested that residents found the method useful for providing holistic self-assessment, facilitating goal setting, uncovering blind spots, and improving feedback interpretation.
Next steps should include studies determining if the association between increased learner satisfaction with written feedback and the LEAF method is causal, and whether this feedback process changes learners' subsequent behaviors.
书面反馈往往过于积极、不具体且难以解读。学习者对书面反馈的满意度较低，难以获得鼓励自我反思的书面反馈。提高反馈质量既费力又效果有限。
作者开发了 LEAF（学习者参与的反馈分析）方法，以提高学习者对现有书面反馈的满意度和反思能力。该方法将学习者和教练配对，系统地识别学习者书面反馈中的主题。出现频率高于或低于典型反馈的主题为反思提供了领域，因为它们可能识别出学习者的相对优势或劣势。该方法于 2017 年在马萨诸塞州综合医院的项目主任（PD）会议上引入麻醉住院医师，2018 年，对 4 种反馈来源的住院医师满意度进行了测量（1 到 5 分李克特量表，1=“一点也不满意”，5=“非常满意”），其中 2 种与 LEAF 方法相关（PD 会议，书面反馈），2 种不相关（口头反馈，导师反馈）。对居民的意见进行了定性评估，以探讨对自我反思的影响。
与未参加 LEAF 会议的居民（n=11）相比，参加过 LEAF 会议的居民（n=54）报告对书面反馈（平均 3.1 分与 2.5 分，d=0.53，P=0.03）和 PD 会议反馈（平均 3.8 分与 2.8 分，d=0.80，P=0.03）的满意度更高。对与 LEAF 方法无关的反馈的满意度在两组之间没有显著差异。对评论的定性分析表明，居民认为该方法有助于提供全面的自我评估、促进目标设定、发现盲点和提高反馈解释。
下一步应包括研究确定增加学习者对书面反馈的满意度与 LEAF 方法之间的关联是否具有因果关系，以及这种反馈过程是否改变学习者的后续行为。
