Attending and Resident Satisfaction with Feedback in the Emergency Department

Authors

  • Lalena M Yarris MD, MCR,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Judith A. Linden MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • H. Gene Hern MD, MS,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Cedric Lefebvre MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • David M. Nestler MD, MS,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Rongwei Fu PhD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Esther Choo MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Joseph LaMantia MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • Patrick Brunett MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF, EC, PB), Department of Public Health and Preventive Medicine (RF), Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, (JAL) Boston, MA; Department of Emergency Medicine, Alameda County – Highland General Hospital, (HGH) Oakland, CA; Department of Emergency Medicine, Wake Forest University Health Sciences, (CL) Winston-Salem, NC; Department of Emergency Medicine, Mayo Clinic, (DMN) Rochester, MN; Department of Emergency Medicine, North Shore University Hospital, (JL) Manhasset, NY.
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  • on behalf of the Emergency Medicine Education Research Group (EMERGe)

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  • Prior Presentations: Presented at the 2008 SAEM Regional Research Forums (Western, New York, Southeastern, and New England), and the SAEM Annual Meeting, May 2008, Washington, DC.

  • CoI: No other financial interests were disclosed.

  • This publication was made possible with support from the Oregon Clinical and Translational Research Institute, grant number UL1 RR024140 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research.

Address for correspondence and reprints: Lalena M. Yarris, MD, MCR; e-mail: yarrisl@ohsu.edu.

Abstract

Objectives:  Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED.

Methods:  This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses.

Results:  Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001).

Conclusions:  Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED.

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