Assessment of Neurosurgical Resident Milestone Evaluation Reporting and Feedback Processes
Katrin Frimannsdottir, Michelle Clarke
Introduction: Structured performance evaluations are important for trainee professional development. The ACGME milestones formalizes summative assessments tracking a learner’s competence trajectory and identifing deficiencies. However, resident satisfaction with feedback is poor.
Objective: The primary aim is to understand the current feedback delivery mechanism, culture of feedback, and the percieved ultility of feedback.
Methods: Face-to-face interviews were conducted with 10 Neurosurgery residents exploring their perceptions of summative feedback. Qualitative results were parsed using the matrix framework method in Nvivo allowing both a priori themes of feedback definition, delivery and impact to be combined with de novo themes discovered during analysis.
Results: All trainees stated that milestones aspirationally provide objective benchmarked measures of progression but felt the milestones provided no useful data to improve performance. The majority of trainees made clear distinctions between formative and summative feedback with immediately relevant, specific and personal feedback being considered most valuable. Receptivity to negative feedback was cautious: the veracity considered before internalization. If validated, learning was more impactful from negative feedback than positive feedback. Milestone feedback was viewed as poor quality due to the limited scope of reviewer analysis, inconsistent reporting, and awkward categorization. All trainees noted that summative feedback was too general to improve performance. A de novo theme revealed gender disparity in language and reduced provision of negative feedback was perceived negatively by all female interviewees.
Conclusions: Trainees view the milestone feedback system skeptically due to limited specificity and reporting inconsistencies. Better integration with formative feedback is required to legitimize the milestone system prior to adopting competency-based education.