Assessment of performance feedback as a teaching-learning tool in the operating room at the National Referral Hospital, Bhutan: a prospective pre-post interventional study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.