Tsyrulnik Alina, Fleming-Nouri Alex, Ikejiani Suzette, Bradby Cassandra, Coughlin Ryan F, Bod Jessica, Della-Giustina David, Goldflam Katja
Yale University School of Medicine New Haven Connecticut USA.
Brigham and Womens Hospital, Harvard Medical School Boston Massachusetts USA.
AEM Educ Train. 2023 Oct 8;7(5):e10915. doi: 10.1002/aet2.10915. eCollection 2023 Oct.
Feedback is critical for physician development. Multisource feedback is especially important in a team-based specialty such as emergency medicine (EM) and is required by the Accreditation Council for Graduate Medical Education. Nursing assessments provide a unique perspective, but little is known about the current national patterns of their collection and use in EM.
We surveyed EM program directors using a mixed-methods approach to explore the use of nursing assessment of EM residents. Descriptive data were reported as absolute numbers and percentages. An adjunct analysis of free-text responses was done using the framework method.
The response rate for our survey was 63% (190 responses), of which 84% currently collect nursing feedback. Respondents from 94% of programs agreed that nursing feedback is useful in assessing professionalism and respondents from 92% of programs agreed that nursing feedback is useful in assessing communication and interpersonal skills, while 44% agreed that it is useful in informing resident medical knowledge. Forty-two percent reported that nursing feedback did not directly influence residents' progression through their training, while 2% indicated that such feedback played a significant role in leading to dismissal or probation. The majority of programs (64%) that do not collect feedback from nurses have done so in the past and hope to do so in the future. Qualitative analysis revealed themes of logistic challenges with data collection, concern regarding quality of feedback, and retributive or gender-disparate feedback.
Nursing assessments of EM residents were collected by most responding programs and majority of those who do not collect them presently wish to do so in the future. They were considered particularly useful in the assessment of interpersonal skills, communication, and professionalism. However, lack of uniform methods for collecting assessment that meaningfully informs resident development and progression represents a challenge and direction for future inquiry.
反馈对医生的成长至关重要。多源反馈在急诊医学（EM）等基于团队的专业中尤为重要，并且是毕业后医学教育认证委员会所要求的。护理评估提供了独特的视角，但目前关于其在急诊医学中收集和使用的全国模式知之甚少。
我们采用混合方法对急诊医学项目主任进行了调查，以探讨对急诊医学住院医师的护理评估的使用情况。描述性数据以绝对数和百分比形式报告。使用框架方法对自由文本回复进行了辅助分析。
我们调查的回复率为63%（190份回复），其中84%目前收集护理反馈。94%的项目的受访者同意护理反馈在评估专业素养方面有用，92%的项目的受访者同意护理反馈在评估沟通和人际技能方面有用，而44%的受访者同意它在告知住院医师医学知识方面有用。42%的人报告说护理反馈没有直接影响住院医师的培训进程，而2%的人表示这种反馈在导致解雇或试用方面起到了重要作用。大多数（64%）没有收集护士反馈的项目过去这样做过，并希望未来这样做。定性分析揭示了数据收集方面的后勤挑战、对反馈质量的担忧以及报复性或性别差异反馈等主题。
大多数回复的项目收集了对急诊医学住院医师的护理评估，大多数目前未收集的项目希望未来这样做。它们在评估人际技能、沟通和专业素养方面被认为特别有用。然而，缺乏统一的评估收集方法，无法有效地为住院医师的发展和进程提供信息，这是未来研究的一个挑战和方向。
