Sherub Karma, Dorjey Yeshey, Dorji Namkha, Tshering Sangay
Department of Pediatric Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Deputy Dean, Academic Affairs, Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
BMC Med Educ. 2024 Dec 19;24(1):1497. doi: 10.1186/s12909-024-06322-0.
Effective, efficient, and enduring feedback on performance improves and accelerates learning in medical education. Basic teaching methods like providing constructive feedback would enhance educational quality. However, briefing and debriefing culture is almost absent in our operating room. Feedback, if at all given, is traditionally negative, pointing out errors, while wanting to draw attention to strengths and success. This study aimed to examine the current status of performance feedback in the operating room and to evaluate the effect of an educational intervention "SHARP" on the quality of performance feedback.
This was a prospective, pre-post interventional study conducted at the National Referral Hospital, in Bhutan. Surgeons (trainers) and the surgical residents (trainees) performing elective surgical cases under general anesthesia were assessed for pre-intervention and post-intervention performance feedback using a validated Objective Structured Assessment of Debriefing (OSAD) based questionnaire. A validated SHARP 5-Step Feedback tool for surgery (Setting up learning objectives, How did it go, Address concerns, Review learning points, and Plan ahead) was used as an intervention. The data were analyzed using SPSS version 23 and the paired t-test was used to compare the pre-post OSAD scores, and p < 0.05 is considered statistically significant.
The existing performance feedback was unacceptably low. With the 'SHARP' intervention, the post-intervention OSAD score significantly increased compared to the pre-intervention score (26.7 ± 1.72 vs. 22.0 ± 2.67 for post-intervention and pre-intervention respectively, effect size 1.9, p < 0.001). An educational tool 'SHARP' effectively improves the quality of feedback in the operating room.
The existing performance feedback is low in the operating room. Performance feedback can be efficient, effective, and enduring if a culture of structured feedback is in place. Educational tools like 'SHARP' can facilitate experiential learning in the surgical classroom.
在医学教育中，关于表现的有效、高效且持久的反馈能够改进并加速学习。像提供建设性反馈这样的基本教学方法会提升教育质量。然而，在我们的手术室中，几乎不存在简报和总结汇报的文化。即使有反馈，传统上也多是负面的，只指出错误，而没有关注优点和成功之处。本研究旨在调查手术室中表现反馈的现状，并评估一种教育干预措施“SHARP”对表现反馈质量的影响。
这是一项在不丹国家转诊医院进行的前瞻性、干预前后对照研究。使用经过验证的基于客观结构化总结汇报评估（OSAD）的问卷，对在全身麻醉下进行择期手术病例的外科医生（培训者）和外科住院医师（受训者）进行干预前和干预后的表现反馈评估。使用经过验证的手术SHARP五步反馈工具（设定学习目标、过程如何、解决问题、回顾学习要点、提前规划）作为干预措施。数据使用SPSS 23版进行分析，配对t检验用于比较干预前后的OSAD分数，p < 0.05被认为具有统计学意义。
现有的表现反馈水平低到令人无法接受。通过“SHARP”干预，干预后的OSAD分数与干预前相比显著提高（干预后为26.7 ± 1.72，干预前为22.0 ± 2.67，效应大小为1.9，p < 0.001）。一种教育工具“SHARP”有效地提高了手术室中的反馈质量。
手术室中现有的表现反馈水平较低。如果建立起结构化反馈的文化，表现反馈可以是高效、有效且持久的。像“SHARP”这样的教育工具可以促进外科教学中的体验式学习。
