O. Onuoha was associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania at the time of writing. She is currently associate professor of anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.
S.J. Heins is a medical student, Georgetown University School of Medicine, Washington, DC.
Acad Med. 2022 Feb 1;97(2):222-227. doi: 10.1097/ACM.0000000000004229.
Formative feedback, given in an ongoing fashion during the learning process, is fundamental to clinical education. However, dissatisfaction with formative feedback among residents is common. Difficulties with formative feedback are intensified in the operating room (OR) setting due to fast pace, space limitations, and frequent rotation of residents and attendings.
In the anesthesiology and critical care department at the University of Pennsylvania Perelman School of Medicine, the authors launched the Feedback Moment initiative from January 2018 to May 2018 in which 24 first-year residents and attendings were given a short series of prompts designed to facilitate regular, high-quality formative feedback. The authors conducted semistructured interviews with residents before and after the initiative to evaluate its impact.
In baseline interviews, 18 participating residents stressed the importance of formative feedback but described feeling unsure of their performance due to lack of ongoing constructive input from attendings. They felt hesitant to approach attendings for feedback due to a desire not to interrupt OR workflow or appear incompetent. In follow-up interviews, residents described the initiative as helping to normalize constructive formative feedback but difficult to execute regularly due to OR workflow issues and frequent rotation of attendings with varying approaches.
Challenges faced by participants in this initiative highlight several considerations for effective OR-based formative feedback. Alternative timings for initiating feedback must be considered in light of the hectic nature of the OR workflow. Residents should be equipped with the skills necessary to adapt to varying practice patterns and frequent rotation between attendings, while attendings should be trained to provide a clear rationale for constructive feedback that allows residents to quickly adapt to practice variation. Finally, establishing clear goals among resident-attending pairs is critical to ensuring that formative feedback given in necessarily brief sessions is focused and productive.
形成性反馈是临床教育的基础，它在学习过程中持续进行。然而，住院医师对形成性反馈普遍不满意。由于手术室（OR）环境的快节奏、空间限制以及住院医师和主治医生的频繁轮换，形成性反馈的困难加剧。
在宾夕法尼亚大学佩雷尔曼医学院的麻醉学和危重病医学系，作者于 2018 年 1 月至 2018 年 5 月发起了“反馈时刻”倡议，24 名第一年住院医师和主治医生收到了一系列简短的提示，旨在促进定期、高质量的形成性反馈。作者在倡议前后对住院医师进行了半结构化访谈，以评估其影响。
在基线访谈中，18 名参与的住院医师强调了形成性反馈的重要性，但由于主治医生缺乏持续的建设性投入，他们对自己的表现感到不确定。他们因不想打断 OR 工作流程或显得无能而不愿向主治医生寻求反馈。在后续访谈中，住院医师表示该倡议有助于使建设性的形成性反馈正常化，但由于 OR 工作流程问题和主治医生的频繁轮换，他们很难定期执行。
参与者在这项倡议中面临的挑战突出了一些需要考虑的因素，以实现有效的基于 OR 的形成性反馈。必须根据 OR 工作流程的繁忙性质考虑反馈的启动时间。必须为住院医师提供适应不同实践模式和主治医生之间频繁轮换的必要技能，同时还应培训主治医生提供明确的建设性反馈理由，使住院医师能够快速适应实践变化。最后，确保在必要的简短会议中给予形成性反馈是有针对性和富有成效的，这一点在住院医师和主治医生之间建立明确的目标至关重要。
