Launching the feedback revolution: Introduction of a structured framework to begin moving the needle on operative feedback

Abstract

Effective feedback is critically important for growth and development. However, feedback is extremely variable as multiple barriers to delivering and soliciting feedback exist. Furthermore, faculty and residents have differing perceptions of feedback. Surgical faculty, residents, and residency program directors were interviewed to explore diverse perceptions of feedback. Emergent themes included: (1) interest in a structured framework, (2) need for designated time for feedback, and (3) importance of departmental buy-in. These findings helped design our feedback framework based on a validated operative teaching model. Our framework is centered on components of brainstorm, focus, and recap (BFR) and promotes intentional, direct feedback through a structured and transparent shared mental model between faculty and residents. We aimed to assess the impact of the BFR framework on the quantity and quality of perioperative feedback between surgical faculty and residents. The BFR framework was introduced to two surgical services for a six-month period. Faculty and residents were invited to utilize the BFR framework for their operative cases. Pre- and post-intervention surveys compared faculty and resident perceptions of feedback. Postoperative surveys monitored weekly use of the framework. A total of 19 faculty and 56 residents were invited to participate in the study. Faculty and upper-level residents indicated greater frequency and satisfaction with feedback after the intervention. Although both cohorts reported overall improvement with technical feedback, discrepancies persisted as faculty continued to report giving more frequent, higher-quality feedback than residents reported receiving. Nevertheless, faculty and residents found the structure of the BFR framework to be valuable in engaging with each other. Feedback plays an indispensable role in surgical training. The BFR framework positively impacted faculty and resident practices and perceptions of feedback, though discrepancies in perceptions remain. Many surrounding pressures of the surgical learning environment can affect the feedback process. Future work should continue optimizing feedback practices and incorporate high-quality feedback with the competency-based assessment system that is approaching implementation in the surgical education community. Targeted initiatives, much like ours, have the potential to transform the culture of feedback in meaningful ways and support the advancement of our residents into confident and competent practice-ready surgeons.