PC3108: A Pilot Study in Training Fellows to Give Residents High Quality Feedback Using R2C2

Background: The importance of feedback is recognized within graduate medical education but its implementation in the clinical setting faces barriers. These include time constraints, lack of training on providing effective feedback, and discrepant power dynamics. Inclusion of fellows in resident feedback may lower some barriers while providing valuable leadership training for the fellows. The current literature lacks any description of such a process so we seek to fill this gap by implementing a fellow-led clinical feedback model for pediatric residents. Our primary aim in this pilot is to evaluate the feasibility of implementing a fellow led feedback program in the pediatric intensive care unit (PICU). Evaluation includes a mixed method evaluation of resident and fellow experiences, including barriers and benefits.

Methods: PICU Fellows
In July, 2021 all PICU fellows were enrolled in this study. Demographic data was collected and a pre-training confidence survey was completed. All fellows completed a workshop in the use of the R2C2 feedback method. Subsequently, fellows began providing twice monthly resident feedback with attending guidance. Semi-structure interviews were conducted after 6 months to evaluate the fellow experience.

Program Implementation
Completion of feedback sessions was evaluated by evaluating the frequency of completed Learning Change Plans (LCPs) – shared educational, actionable objectives completed by the fellow and resident.

Resident Experience
Baseline pediatric resident data was collected using existing resident evaluations of the PICU rotation over the 12 months before and the 4 months after we instituted this program. We performed descriptive statistics on two questions that residents answered using a five-point Likert scale: (1) evaluate the quality of feedback during the rotation and (2) evaluate the feedback provided by the attending.

Results: 5 PICU fellows completed the confidence survey and training and led at least one feedback session. Pre-training confidence survey suggested a general discomfort with providing feedback - 20% of responses demonstrated a high level of confidence. Semi-structured interviews revealed common benefits following training and practice – more clear expectations and a useful framework; and barriers – lack of time and competing clinical duties. During the pilot, 58% (N=33) of residents had a completed LCP. Resident evaluations of feedback during the rotation were higher pre-intervention compared to the post (N=74 vs 27). However, the results were similar pre- and post-intervention: 3.26/5 ± 0.89 vs 3.75/5 ± 0.85 (p=0.18). Evaluations of attendings were also similar: 3.65/5 ± 0.75 vs 3.45/5 ± 0.7 (p=0.06).

Conclusion: This pilot study demonstrates that a fellow led feedback model for residents is feasible in a tertiary pediatric residency program with a benefit to both fellows and residents. Further studies will evaluate the implementation across pediatric fellowships at this institution.