Effectively Acquiring and Using Feedback

CASE STUDIES IN TRAINING AND EDUCATION Effectively Acquiring and Using Feedback David M. Naeger, MD, Aaron Jen, BA, Bren Ahearn, MA, Emily M. Webb, MD DESCRIPTION OF THE PROBLEM Feedback is a vital component of medical education [1,2]. Feedback can hone an educator’s teaching skills, guide the evolution of a cur- riculum, and improve the experience of students [3,4]. However, feedback systems are easily hampered by pit- falls and often implemented without sufﬁcient scrutiny or review [5]. When feedback is not collected properly, it can be difﬁcult to use. For example, collecting too little feedback can provide insufﬁcient information, and too much feedback (or feedback that has accumulated) can be overwhelming. Delays in receiving or processing feedback limit the likelihood of effecting timely change. When feedback is of poor quality, its utility is decreased [6]. The biggest cause of poor feedback is “feedback fatigue” [7], soliciting feedback so frequently that partic- ipation drops and the results are terse and prone to response bias. Additionally, overly vague or spe- ciﬁc feedback has been shown to be less effective [6], as has exclu- sively positive or exclusively nega- tive feedback [8]. Off-the-cuff verbal feedback seems to lack crit- ical analysis, compared with writ- ten feedback [9]. Finally, actually doing some- thing with the feedback is required for it to be effective. Commonly, the energy, time, or motivation required to make improvements is lacking, despite the availability of sufﬁcient feedback. Some studies have suggested that physi- cians, as a group, often tend to overestimate their performance [10], thereby limiting their will- ingness to change. In some cases, feedback must be combined with mentorship to effect meaningful change [5,10,11]. Herein, we discuss a multiyear process of critically reviewing and improving our feedback system in the largest course offered by our department—the core medical stu- dent radiology elective, in which approximately 100 students enroll per year. In particular, we focus on how our feedback systems could improve the instruction provided, while promoting educators and the educational program. WHAT WAS DONE Deﬁnition of Feedback Goals Our ﬁrst step was to create a list of goals for our feedback system. Through a collaborative process, all members of the radiology elective’s leadership determined the charac- teristics of an effective feedback sys- tem, which were as follows: 1. All requested feedback should be useful (ie, actionable): n No redundant questions; n No questions about things that cannot be changed; Questions speciﬁcally assessing a targeted area of concern should be removed after sufﬁcient in- formation has been acquired. Feedback should be required of all students, to ensure a repre- sentative set of comments and codify the expectation that everyone is responsible for help- ing improve the educational experience. Feedback should be acquired in a timely manner, ideally the same day as the activity. Feedback should be reviewed in a timely manner, ideally within a few days. Feedback should result in changes (except when the feed- back indicates the current state is as good as can reasonably be achieved). Positive feedback should be used to support and promote educators and the educational program. n To achieve the preceding goals, the leadership decided that both daily feedback and “end-of-course” feedback were needed. Acquiring Daily Feedback Students were asked to provide constructive daily feedback on all activities, via the course’s online learning portal. To minimize “feedback fatigue,” the daily online form was parsimonious, including a required attendance veriﬁcation question and only 2 n a 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2015.05.011