Abstract
Purpose
Feedback is a cornerstone of medical education. However, not all feedback that residents receive is high-quality. Natural language processing (NLP) can be used to efficiently examine the quality of large amounts of feedback. We used a validated NLP model to examine factors associated with the quality of feedback that general surgery trainees received on 24,531 workplace-based assessments of operative performance.
Methods
We analyzed transcribed, dictated feedback from the Society for Improving Medical Professional Learning’s (SIMPL) smartphone-based app. We first applied a validated NLP model to all SIMPL evaluations that had dictated feedback, which resulted in a predicted probability that an instance of feedback was “relevant”, “specific”, and/or “corrective.” Higher predicted probabilities signaled an increased likelihood that feedback was high quality. We then used linear mixed-effects models to examine variation in predictive probabilities across programs, attending surgeons, trainees, procedures, autonomy granted, operative performance level, case complexity, and a trainee’s level of clinical training.
Results
Linear mixed-effects modeling demonstrated that predicted probabilities, i.e., a proxy for quality, were lower as operative autonomy increased (“Passive Help” B = − 1.29, p < .001; “Supervision Only” B = − 5.53, p < 0.001). Similarly, trainees who demonstrated “Exceptional Performance” received lower quality feedback (B = − 12.50, p < 0.001). The specific procedure or trainee did not have a large effect on quality, nor did the complexity of the case or the PGY level of a trainee. The individual faculty member providing the feedback, however, had a demonstrable impact on quality with approximately 36% of the variation in quality attributable to attending surgeons.
Conclusions
We were able to identify actionable items affecting resident feedback quality using an NLP model. Attending surgeons are the most influential factor in whether feedback is high quality. Faculty should be directly engaged in efforts to improve the overall quality of feedback that residents receive.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Jackson JL, Kay C, Jackson WC, Frank M. The quality of written feedback by attendings of internal medicine residents. J Gen Intern Med. 2015;30(7):973–8. https://doi.org/10.1007/s11606-015-3237-2.
Bing-You RG, Trowbridge RL. Why medical educators may be failing at feedback. JAMA. 2009;302(12):1330–1.
Jug R, Jiang X “Sara”, Bean SM. Giving and receiving effective feedback: a review article and how-to guide. Arch Pathol Lab Med 2019;143(2):244–250. https://doi.org/10.5858/arpa.2018-0058-RA
Hewson MG, Little ML. Giving feedback in medical education. J Gen Intern Med. 1998;13(2):111–6. https://doi.org/10.1046/j.1525-1497.1998.00027.x.
Lefroy J, Watling C, Teunissen PW, Brand P. Guidelines: the do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ. 2015;4(6):284–99. https://doi.org/10.1007/s40037-015-0231-7.
Jensen AR, Wright AS, Kim S, Horvath KD, Calhoun KE. Educational feedback in the operating room: a gap between resident and faculty perceptions. Am J Surg. 2012;204(2):248–55. https://doi.org/10.1016/J.AMJSURG.2011.08.019.
Bello RJ, Sarmiento S, Meyer ML, et al. Understanding surgical resident and fellow perspectives on their operative performance feedback needs: a qualitative study. J Surg Educ. 2018;75(6):1498–503. https://doi.org/10.1016/J.JSURG.2018.04.002.
Rose JS, Waibel BH, Schenarts PJ. Disparity between resident and faculty surgeons’ perceptions of preoperative preparation, intraoperative teaching, and postoperative feedback. J Surg Educ. 2011;68(6):459–64. https://doi.org/10.1016/J.JSURG.2011.04.003.
Kornegay JG, Kraut A, Manthey D, et al. Feedback in medical education: a critical appraisal. AEM Educ Train. 2017;1(2):98–109. https://doi.org/10.1002/aet2.10024.
McKendy KM, Watanabe Y, Lee L, et al. Perioperative feedback in surgical training: a systematic review. Am J Surg. 2017;214(1):117–26. https://doi.org/10.1016/J.AMJSURG.2016.12.014.
Norcini JJ. Workplace assessment. In: Understanding medical education: evidence, theory and practice. Wiley, 2013; 2013. https://books.google.com/books?hl=en&lr=&id=EWsKAgAAQBAJ&oi=fnd&pg=PA279&dq=Norcini+Workplace+assessment&ots=5SNX3lR8VE&sig=GZgxsYdM7MDc_xsrIiKvbnj1fv8. Accessed 15 May 2022.
Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29(9-10):855-871. https://doi.org/10.1080/01421590701775453
Solano QP, Hayward L, Chopra Z, et al. Natural language processing and assessment of resident feedback quality. J Surg Educ. 2021;78(6):e72–7. https://doi.org/10.1016/J.JSURG.2021.05.012.
Ötles E, Kendrick DE, Solano QP, et al. Using natural language processing to automatically assess feedback quality: findings from 3 surgical residencies. Acad Med. 2021. https://doi.org/10.1097/ACM.0000000000004153.
George BC, Bohnen JD, Schuller MC, Fryer JP. Using smartphones for trainee performance assessment: a SIMPL case study. Surgery. 2020;167(6):903–6. https://doi.org/10.1016/j.surg.2019.09.011.
Bohnen JD, George BC, Williams RG, et al. The Feasibility of real-time intraoperative performance assessment with SIMPL (system for improving and measuring procedural learning): early experience from a multi-institutional trial. J Surg Educ. 2016;73(6):e118–30. https://doi.org/10.1016/j.jsurg.2016.08.010.
Williams RG, George BC, Bohnen JD, et al. A proposed blueprint for operative performance training, assessment, and certification. Ann Surg. 2021. https://doi.org/10.1097/SLA.0000000000004467.
Ahle SL, Eskender M, Schuller M, et al. The quality of operative performance narrative feedback: a retrospective data comparison between end of rotation evaluations and workplace-based assessments. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000003907.
DaRosa DA, Zwischenberger JB, Meyerson SL, et al. A theory-based model for teaching and assessing residents in the operating room. J Surg Educ. 2013;70(1):24–30. https://doi.org/10.1016/j.jsurg.2012.07.007.
Kogan JR, Conforti LN, Bernabeo EC, Durning SJ, Hauer KE, Holmboe ES. Faculty staff perceptions of feedback to residents after direct observation of clinical skills. Med Educ. 2012;46(2):201–15. https://doi.org/10.1111/j.1365-2923.2011.04137.x.
Junod Perron N, Nendaz M, Louis-Simonet M, et al. Effectiveness of a training program in supervisors’ ability to provide feedback on residents’ communication skills. Adv Heal Sci Educ. 2013;18(5):901–15. https://doi.org/10.1007/s10459-012-9429-1.
Minehart RD, Rudolph J, Pian-Smith MCM, Raemer DB. Improving faculty feedback to resident trainees during a simulated case: a randomized, controlled trial of an educational intervention. Anesthesiology. 2014;120(1):160–71. https://doi.org/10.1097/ALN.0000000000000058.
Zendejas B, Toprak A, Harrington AW, Lillehei CW, Modi BP. Quality of dictated feedback associated with SIMPL operative assessments of pediatric surgical trainees. Am J Surg. 2021;221(2):303–8. https://doi.org/10.1016/j.amjsurg.2020.10.014.
Baker K. Clinical teaching improves with resident evaluation and feedback. Anesthesiology. 2010;113(3):693–703. https://doi.org/10.1097/ALN.0b013e3181eaacf4.
Springer MV, Sales AE, Islam N, et al. A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies. Implement Sci. 2021;16(1):35. https://doi.org/10.1186/s13012-021-01102-6.
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Marcotte, K.M., Ötleş, E., Thelen, A.E. et al. Using natural language processing to determine factors associated with high-quality feedback. Global Surg Educ 1, 58 (2022). https://doi.org/10.1007/s44186-022-00051-y
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DOI: https://doi.org/10.1007/s44186-022-00051-y