2019 HSC Section 2 - Practice Management

Reprinted by permission of J Surg Educ. 2018; 75(6):e246-e254.

ARTICLE IN PRESS

ORIGINAL REPORTS

Examining the Impact of Using the SIMPL Application on Feedback in Surgical Education

D1 X X Kirsten Gunderson, D2 X X D9 X X Jacob A. Greenberg, D10 X X

BS, *

D3 X X Sarah Sullivan, D4 X X

PhD, *

D5 X X Charles Warner-Hillard, D6 X X

MSPH, *

D7 X X Ryan Thompson, D8 X X

MD, †

MD, EdM, * D11 X X

Eugene F. Foley, D12 X X

MD, * and, D13 X X

Hee Soo Jung, D14 X X

MD *

* University of Wisconsin, Department of Surgery, Madison, Wisconsin; and † University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin

OBJECTIVE: The System for Improving and Measuring Procedural Learning (SIMPL) smartphone application allows physicians to provide dictated feedback to surgi- cal residents. The impact of this novel feedback medium on the quality of feedback is unknown. Our objective was to compare the delivery and quality of best-case operative performance feedback given via SIMPL to feed- back given in-person. DESIGN: We collected operative performance feedback given both in-person and via SIMPL from surgeons to res- idents over 6 weeks. Feedback transcripts were coded using Verbal Response Modes speech acts taxonomy to compare the delivery of feedback. We evaluated quality of feedback using a validated resident survey and third- party assessment form. SETTING: University of Wisconsin School of Medicine and Public Health, a large academic medical institution. PARTICIPANTS: Four surgical attendings and 9 general surgery residents. RESULTS: Nineteen SIMPL and 18 in-person feedback encounters were evaluated. Feedback via SIMPL was more directive (containing thoughts, perceptions, evalu- ations of resident behavior, or advice) and contained more presumptuous utterances (in which the physician reflected on and assessed resident performance or offered suggestions for improvement) than in-person feedback (p = 0.01). The resident survey showed no significant difference between the quality of feedback given via SIMPL and in- person (p = 0.07). The mean score was 47.74 Funding: This work was funded by the University of Wisconsin, School of Medi- cine and Public Health and conclusions do not reflect the views of the funding agencies, cooperating institutions, or other individuals. Correspondence : Inquiries to Hee Soo Jung, MD, University of Wisconsin, Department of Surgery, 600 Highland Avenue, CSC G5/332, Madison, WI 53792; fax: 608-252-0917; e-mail: jung@surgery.wisc.edu

(SD = 3.00) for SIMPL feedback and 45.33 (SD = 4.77) for in-person feedback, with a total possible score of 50. Third-party assessment showed no significant differ- ence between the quality of feedback given via SIMPL and in-person (p = 0.486). The mean score was 23.40 (SD = 3.75) for SIMPL feedback and 22.25 (SD = 5.94) for in-person feedback, with a total possible score of 30. CONCLUSIONS: Although feedback given via SIMPL was more direct and based on the attendings’ perspec- tives, the quality of the feedback did not differ signifi- cantly. Use of the dictation feature of SIMPL to deliver resident operative performance feedback is a reasonable alternative to in-person feedback. ( J Surg Ed 000:1 9. 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: Feedback, Graduate medical education, Surgical education, Verbal response modes, Speech act theory. ACGME Competency Addressed: Practiced-Based Learning and Improvement Feedback in the educational setting has consistently been shown to improve performance by facilitating an understanding of current performance that can be used to develop effective strategies to reach a target performance. 1-3 Incorporation of feedback in medical education, specifically, has been shown to improve healthcare practice, and health professions education experts agree that feedback is an integral part of medi- cal education. 3,4 Even so, trainees, such as surgical residents, indicate that the feedback they receive is often neither timely nor effective. 5 INTRODUCTION

Journal of Surgical Education

© 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

1931-7204/$30.00 https://doi.org/10.1016/j.jsurg.2018.08.009

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