Virginia Mason, Seattle, WAPause for Feedback

Background: Effective feedback is necessary to reinforce positive behavior, correct deficits in clinical knowledge and skills, and provide residents with an understanding of their progress and opportunities. Our goal was to advance the culture of QI and PS and enrich faculty and resident educational experience by improving competence of team members who give and receive feedback. Both resident and faculty surveys identify feedback as the top development opportunity within GME. Methods: Initial investigation revealed a gap between resident and faculty perceptions about the frequency of feedback provision. In all GME programs, 72% of faculty reported providing feedback at least weekly; only 46% of residents reported receiving feedback weekly. A Pause for Feedback process and checklist tool were implemented in the radiology and anesthesiology programs. Residents and faculty were briefed on the new process. In radiology, residents were asked to initiate the request for face-to-face feedback at least 1 time each week from faculty of their choice. Anesthesiology incorporated the checklist into an established weekly feedback process. Faculty were asked to actively participate in and to validate the resident9s self-appraisal and to verbally guide improvement strategies and tactics. Results: The most successful component of our work was faculty and resident engagement in the process. Both participating departments saw increased concordance between faculty and resident perception of the frequency of feedback exchanged. Scheduling difficulties when working across multiple GME programs restricted the time available to work collaboratively. The process of team visioning delayed fail forward fast and rapid-cycle PDSA implementation. Sample size was limited. Conclusions: Using a checklist and allowing GME programs to operationalize a process for weekly feedback resulted in increased concordance in resident and attending perceptions of frequency of feedback. Different processes for implementing Pause for Feedback were equally effective in radiology and anesthesiology programs.