K.A. LaDonna is associate professor, Department of Innovation in Medical Education and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4738-0146.
L. Cowley is a research assistant, Department of Medicine, Faculty of Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0002-0077-444X.
Acad Med. 2023 Nov 1;98(11S):S72-S78. doi: 10.1097/ACM.0000000000005362. Epub 2023 Aug 2.
Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review.
Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body-mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory.
Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees' concerns. Reasons included that most feedback was "validating," aimed at "tweaks" rather than substantial change.
This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.
安全、胜任的患者护理取决于医生识别和纠正绩效缺陷的能力。产生有效的洞察力取决于来自可信来源的反馈。不幸的是，医生通常获得有意义的指导的机会有限。为了促进质量改进，许多监管机构设计了同行协助的实践增强计划。然而，他们确保实践质量的任务可能会在形成性意图和风险（感知或其他）之间产生紧张关系，从而产生总结性影响。本研究探讨了医生在需要接受审查时如何处理反馈。
在 2018 年 10 月至 2020 年 5 月期间，30 名代表各种专业和职业阶段的医生接受了采访，他们在监管机构规定的计划背景下分享了他们在同行审查方面的经验。其中 20 人既是审查员又是被审查者，因此可以从两个角度进行发言。使用基于建构主义扎根理论的 3 阶段编码过程分析访谈记录。
对强制性同行审查的学习价值的看法不一。大多数人认为有价值，但由于担心监管机构而对被选中感到焦虑。审查员认识到这些看法可能造成的障碍，描述了优化与被审查者互动价值的技术。他们的策略与他们接受培训的 R2C2 反馈和辅导模式一致，但并不总是能克服被审查者的担忧。原因包括，大多数反馈是“验证性”的，旨在进行“微调”，而不是进行实质性的改变。
本研究确立了一个有趣而具有挑战性的悖论：当反馈不构成威胁时，它似乎往往不被视为反馈，但反馈带来这种威胁的情况下，反馈被认为不利于提高绩效。为了解决这种紧张关系，作者建议，如果通过前馈而不是反馈来管理预期，那么对于那些绩效极有可能很强的个人来说，同行审查可能会更有效。
