Photo by Piotr Bodzek
New research suggests that individualized feedback is more effective than group instructions for helping general surgery residents prevent venous thromboembolism (VTE) in their patients.
The single-center study showed that regular, one-on-one feedback and written report cards helped ensure the use of correct VTE prophylaxis more effectively than the usual group lectures that newly minted surgeons receive as part of their training.
These results were published in Annals of Surgery.
The study, conducted between July 2013 and March 2014, involved 49 general surgery residents in their first through fifth year of training at Johns Hopkins Hospital in Baltimore, Maryland.
For the first 3 months, residents received no personalized feedback. For the following 3 months, they received an electronic score card via email detailing their individual performance, including how many times they prescribed the appropriate VTE prophylaxis, how many times they failed to do so, and how they fared compared with others.
For the next 3 months, all residents continued to receive monthly scores, but subpar performers—those who failed to prescribe appropriate treatment to every single patient they cared for—also received one-on-one coaching from a senior resident.
In the span of 6 months, this approach decreased—from 3 to 0—the number of preventable complications among surgery patients (complications occurring in patients who didn’t receive appropriate VTE prophylaxis).
In the 3-month period prior to deploying the personalized feedback strategy, 7 out of 865 surgical patients developed complications. Three of the 7 cases were subsequently identified as preventable. In comparison, there were no such preventable complications after residents received individualized feedback.
As a result of the feedback, the number of patients getting appropriate treatment increased from 89% to 96%.
The number of residents who performed at 100% (prescribing the correct treatment to every patient all the time) went up from 22 (45%) to 38 (78%). Most of the prescription failures—19 out of 28 such cases—were clustered in a group of 4 residents.
“Our results show that personalized, concrete feedback can be a form of forced introspection that improves self-awareness and decision-making on clotting prophylaxis,” said Elliott Haut, MD, PhD, of the Johns Hopkins University School of Medicine.
Beyond that, Dr Haut and his colleagues believe these results illustrate the notion that simple interventions can be harnessed to foster learning and improve performance among any frontline clinician.
“Speaking more broadly, why stop with residents? Why stop with anticlotting prophylaxis?” Dr Haut asked. “If our findings are borne out by larger studies, this approach could be harnessed to improve training and outcomes for anyone who touches a patient, from nurses to physicians to physical therapists.”
