Assessment and feedback in surgical training

Abstract

This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. In the first study, we report a number of barriers that might prevent supervisors from providing constructive feedback to medical trainees, including a fear of being labeled as intimidating or harassing. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees including insufficient documentation, a perceived lack of support from program leadership, insufficient opportunities to observe performance, competing demands on time, fear of appeals or legal action, and fear of reciprocated poor staff evaluations. The second study examines the effectiveness of two new tools for assessing trainees’ performance and determines that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Participants reported that the new tools were helpful for improving learning in six ways: by sparking a dialogue regarding performance; by promoting a structured, procedure-specific framework which could be used as a mechanism for providing high quality feedback; by providing a framework for directing future learning; by facilitating a systematic tracking of progress over time; by promoting an increased motivation to learn; and by introducing a learning focus to the intraoperative environment. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessments and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care.