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Performance feedback on operative skills is an essential component of surgical training,
potentially impacting trainee attitudes, skill acquisition, and competence.
Additionally, feedback may positively impact patient outcomes.
However, providing effective feedback in today’s dynamic healthcare environment has
become increasingly challenging, given increasing patient demands, pressures for cost
containment, and reduced trainee duty hours.
Understanding the complex feedback environment from trainees’ point of view may help
overcome barriers in the feedback experience and optimize its benefits.
This study aimed to understand surgical trainees’ views on their operative performance
feedback needs and the extent to which performance rating tools can help meet those
A research fellow trained in qualitative methods conducted semistructured interviews
with surgical trainees. Participants included residents and clinical fellows in general
surgery and plastic and reconstructive surgery at Johns Hopkins and 4 other institutions.
Recruitment and question order were informed by emerging data from previous interviews.
Thematic analysis was performed on recurring themes generated during interviews. The
Johns Hopkins Institutional Review Board acknowledged this study as exempt from review.
We conducted 20 interviews: 8 junior residents, 8 senior residents, and 4 clinical
fellows. Fifteen participants were in plastic surgery (75%); 5 were in general surgery;
and 18 were men (90%). Seventeen participants (85%) reported that feedback was very
or extremely important in their surgical training. All trainees (100%) stated that
verbal, face-to-face feedback is the most valuable type of feedback, especially if
occurring during (94%) or immediately after (44%) cases. Timeliness greatly influences
feedback value because it is still useful for trainees if it is received within 1
week of the event, improving event recall and making feedback more actionable. This
was of interest to trainees who seek to improve within the rotation. Trainees defined
good feedback as that which is “objective, current, evaluative, formative, accurate
and not easily dismissible as just an opinion.” They preferred actionable recommendations
in the format of “what you did well…,” “what you did wrong…,” and “what you can do
to improve…” When asked about the role of performance rating tools in feedback, 6
trainees viewed these tools as potentially useful adjuncts if they did not replace
face-to-face feedback. Seven trainees stated that performance rating tools can prompt
face-to-face feedback if the evaluator is committed to the feedback process. Three
residents acknowledged performance rating tools as an opportunity for benchmarking
among peers. Main barriers to assessment tool completion include increased administrative
burden (ie, “1 more thing”) and scores too simplistic to provide meaningful feedback
(ie, “just a number”).
Verbal, face-to-face feedback is very or extremely important to surgical trainees.
Ideally, feedback would be given during or immediately after cases and is still valuable
if given within 1 week of the event. Performance rating tools can be useful aids for
providing feedback, but they should not replace face-to-face interactions. Assessment
tools that can be used to increase the frequency and quality of feedback may help
accelerate trainee skill acquisition, potentially improving the quality and efficiency
of surgical training.
Journal ID (nlm-ta): Plast Reconstr Surg Glob Open
Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open
Journal ID (publisher-id): GOX
Plastic and Reconstructive Surgery Global Open
Wolters Kluwer Health
Publication date Collection:
From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University
School of Medicine, Baltimore, Md.
Carisa M. Cooney, MPH, CCRP, Department of Plastic and Reconstructive Surgery, Johns
Hopkins University School of Medicine, 601N. Caroline St., JHOC 8163, Baltimore, MD