Leclair Rebecca, Ho Jessica S S, Braund Heather, Kouzmina Ekaterina, Bruzzese Samantha, Awad Sara, Mann Steve, Zevin Boris
School of Medicine, Queen's University, Kingston, ON, Canada.
Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
J Med Educ Curric Dev. 2023 May 16;10:23821205231175734. doi: 10.1177/23821205231175734. eCollection 2023 Jan-Dec.
The transition to competency-based medical education (CBME) has increased the volume of residents' assessment data; however, the quality of the narrative feedback is yet to be used as feedback-on-feedback for faculty. Our objectives were (1) to explore and compare the quality and content of narrative feedback provided to residents in medicine and surgery during ambulatory patient care and (2) to use the Deliberately Developmental Organization framework to identify strengths, weaknesses, and opportunities to improve quality of feedback within CBME.
We conducted a mixed convergent methods study with residents from the Departments of Surgery (DoS; = 7) and Medicine (DoM; = 9) at Queen's University. We used thematic analysis and the Quality of Assessment for Learning (QuAL) tool to analyze the content and quality of narrative feedback documented in entrustable professional activities (EPAs) assessments for ambulatory care. We also examined the association between the basis of assessment, time to provide feedback, and the quality of narrative feedback.
Forty-one EPA assessments were included in the analysis. Three major themes arose from thematic analysis: Communication, Diagnostics/Management, and Next Steps. Quality of the narrative feedback varied; 46% had sufficient evidence about residents' performance; 39% provided a suggestion for improvement; and 11% provided a connection between the suggestion and the evidence. There were significant differences between DoM and DoS in quality of feedback scores for evidence (2.1 [1.3] vs. 1.3 [1.1]; < 0.01) and connection (0.4 [0.5] vs. 0.1 [0.3]; = 0.04) domains of the QuAL tool. Feedback quality was not associated with the basis of assessment or time taken to provide feedback.
The quality of the narrative feedback provided to residents during ambulatory patient care was variable with the greatest gap in providing connections between suggestions and evidence about residents' performance. There is a need for ongoing faculty development to improve the quality of narrative feedback provided to residents.
向基于胜任力的医学教育（CBME）的转变增加了住院医师评估数据的量；然而，叙述性反馈的质量尚未被用作针对教师的反馈的反馈。我们的目标是：（1）探索并比较在门诊患者护理期间提供给内科和外科住院医师的叙述性反馈的质量和内容；（2）使用刻意发展组织框架来识别基于胜任力的医学教育中反馈质量的优势、劣势和改进机会。
我们对女王大学外科系（DoS；n = 7）和内科系（DoM；n = 9）的住院医师进行了一项混合收敛性方法研究。我们使用主题分析和学习评估质量（QuAL）工具来分析门诊护理可托付专业活动（EPA）评估中记录的叙述性反馈的内容和质量。我们还研究了评估依据、提供反馈的时间与叙述性反馈质量之间的关联。
41项EPA评估纳入分析。主题分析产生了三个主要主题：沟通、诊断/管理和下一步计划。叙述性反馈的质量各不相同；46%有关于住院医师表现的充分证据；39%提供了改进建议；11%在建议与证据之间建立了联系。在QuAL工具的证据（2.1 [1.3] 对1.3 [1.1]；P < 0.01）和联系（0.4 [0.5] 对0.1 [0.3]；P = 0.04）领域，DoM和DoS在反馈分数质量上存在显著差异。反馈质量与评估依据或提供反馈所需时间无关。
在门诊患者护理期间提供给住院医师的叙述性反馈质量参差不齐，在提供建议与住院医师表现证据之间的联系方面差距最大。需要持续开展教师培训以提高提供给住院医师的叙述性反馈的质量。
