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Strengths and challenges in residency assessment and feedback programs: Results of site interviews from a five-site case study.


Boudreau M, Mann K, Sargeant J. — Dalhousie University

Ross K. — American Board of Internal Medicine

Presented: Conference on Canadian Medical Education, April 2016

Background/Purpose: We conducted research to explore the giving, receiving and use of feedback in five residency programs in three countries using a case-study approach. Earlier research taught us that multiple cultural, individual and relationship factors influence the assimilation, acceptance and use of feedback and that it is a complex phenomenon. In this study, we explored the feedback culture, structure and practices in the five different sites for the purpose of understanding their influence upon the giving and receiving of feedback.

Methods: We conducted and recorded structured interviews via telephone or Skype with the program director at each site. Three team members analyzed data using content analysis. We discussed and clarified any inconsistencies.

Results: A variety of approaches to feedback (3-12 per site) were used, with some overlap. A total of 20 different approaches were used but no approach was used across all sites. The more common approaches were in-training evaluation reports (ITERS), multi-source feedback, mock orals and resident self-assessments. Some approaches, such as field notes, daily encounter cards, mini-CEX, direct observation and reflection were used only at one site. Frequency of feedback ranged from daily to bi-monthly. In some programs the resident was responsible for collecting feedback on their performance and creating action plans. All the sites discussed various strengths and difficulties within their feedback processes, along with the 'feedback culture' at their site.

Conclusion: There is diversity in approaches across sites. Sites agreed that there are strengths and difficulties in any approach, especially when delivering difficult feedback. Findings will enable comparison of the assessment and feedback strategies used with the end goal of strengthening the assessment and feedback provided in residency education.

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