Feedback Matters: Transforming Systems for Meaningful Resident Evaluations
Mona Hedayat, MD
Published January 23, 2025 | Clinics in Medical Education
Issue 5 | Volume 1 | January 2025
Feedback is a cornerstone of effective medical education, allowing learners to identify their strengths, address areas for improvement, and progress toward their full potential. We are aiming to implement a comprehensive feedback structure designed to foster continuous learning and development. This system includes daily feedback, summative feedback at the end of rotations, and formal evaluations aligned with ACGME milestones. Each component serves a distinct yet complementary purpose in supporting our residents’ professional growth.
Daily Feedback: Real-Time Insights
Daily feedback provides residents with immediate, actionable insights into their clinical performance. This type of feedback is typically delivered by attending anesthesiologists at the end of a case or a clinical shift. It focuses on specific aspects of the resident’s performance, such as technical skills, decision-making, communication, or situational awareness.
Summative Feedback: End-of-Rotation Evaluations
While daily feedback focuses on specific moments, summative feedback provides a broader evaluation of a resident’s performance over an entire rotation. End-of-rotation feedback is structured to offer a more holistic view of the resident’s progress in the context of the rotation’s goals and objectives.
This feedback is typically delivered by the rotation director, who synthesizes input from multiple attendings and team members who worked with the resident. It encompasses clinical performance, professionalism, teamwork, and adaptability, among other key competencies. The summative nature of this feedback allows residents to understand how they have developed over several weeks and how their performance aligns with expectations for their level of training. In addition, end-of-rotation feedback serves as an opportunity to set specific goals for the next stage of training.
ACGME Milestone Evaluations: Tracking Longitudinal Development
The ACGME milestone evaluations represent the most formalized component of the feedback system at BIDMC. These evaluations occur semiannually and are conducted by the Clinical Competency Committee (CCC). Milestones are structured to assess residents’ progression in key competency areas, such as patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice.
Unlike daily or summative feedback, milestone evaluations track residents’ development over time, providing a longitudinal perspective on their training. Each resident is evaluated against predefined benchmarks that reflect their level of training, from beginner to advanced. This structured approach ensures that residents are on track to meet the competencies required for independent practice by the end of their residency.
At BIDMC, milestone evaluations are informed by multiple data points, including daily and summative feedback, procedure logs, and self-assessments. This comprehensive approach ensures that milestone assessments are both accurate and reflective of the resident’s overall performance. Additionally, these evaluations provide a framework for meaningful discussions during semiannual meetings with faculty mentors, where residents can reflect on their progress and set long-term goals.
Feedback Platforms: Challenges of the Old Systems
Previously, our feedback system relied on multiple platforms, including daily feedback emails, MyTIPreport, and Medhub. While each platform aimed to address specific aspects of resident evaluation, the use of multiple tools resulted in fragmented information. Feedback was scattered across various systems, making it challenging to consolidate and create comprehensive summaries of resident performance. This fragmentation not only created inefficiencies in tracking progress but also hindered our ability to identify trends or provide actionable, longitudinal feedback.
Furthermore, the presence of multiple platforms caused confusion among attendings regarding which tool to use. Without clear guidelines or a streamlined process, many attendings were unsure where or how to submit their feedback, leading to inconsistent participation. As a result, the feedback response rate was significantly low, limiting the effectiveness of our evaluation process. This inconsistency ultimately affected the residents’ ability to receive timely and meaningful feedback, an essential component of their learning and professional development.
The need for a more unified and efficient system became evident, prompting efforts to restructure and simplify the feedback process to better serve both faculty and residents.
Feedback Platforms: Streamlining the New System
We recently launched a new feedback platform integrated into the anesthesia portal, aiming to simplify and streamline the feedback process for both residents and attendings. This platform consolidates daily feedback and end-of-rotation feedback into one centralized location, addressing previous challenges of fragmented systems and scattered information. The goal is to provide a more efficient, user-friendly tool that enhances the overall quality and accessibility of feedback.
The system is designed to streamline the assignment of feedback evaluations across all rotations. While this is a work in progress, we have already launched the OR daily feedback and ad hoc evaluations. Plans are underway to expand daily feedback capabilities to other key areas such as OB, APS/regional, PACU, and PAT soon. Once the daily feedback structure is fully implemented, our next focus will be on rolling out end-of-rotation feedback for various rotations and subspecialties. These phased efforts reflect our commitment to creating a comprehensive, centralized feedback system that meets the needs of both faculty and residents.
Through this new platform, attendings can easily access all feedback evaluations assigned to them, create ad hoc evaluations for specific cases or situations, and review feedback completed by residents for attendings. This integrated design ensures a seamless experience, empowering attendings to actively participate in the feedback process while fostering transparency and collaboration within the department.
We are confident that this centralized approach will not only improve compliance but also foster enthusiasm among attendings to engage more actively in providing feedback. By addressing inefficiencies and simplifying the process, we believe this platform will significantly enhance the educational experience for our residents and strengthen our department’s commitment to continuous learning and improvement.