How residents really feel about peer-to-peer feedback

Residency may be set up for trainees to learn primarily from attending physicians, but a new study from the Journal of Graduate Medical Education reveals that residents also look to their peers for helpful feedback and guidance. Find out what residents really want in peer evaluations and how residency programs can improve their peer feedback processes.

The study is based on data from a survey of 30 family medicine residents at the University of Michigan, who were piloting an online peer assessment tool. Researchers conducted a brief survey and 60-minute focus groups with residents regarding their perceptions of giving and receiving peer feedback. Of the 30 residents in the study, 28 provided survey responses about the peer feedback process, and 21 participated in focus group discussions.

In the study, 89 percent of residents said that they found information on peer evaluations useful. Survey responses also revealed residents’ unique perceptions of the value of peer feedback and drivers to their professional development. These included:

• Residents value the “authenticity of peer feedback,” with 89 percent of participants reporting that peer evaluations provided “unique information.” Residents also noted that “peers often provide feedback on situations that otherwise go unnoticed or unaddressed by attending [physicians].”
• 92.6 percent of residents said they would change their behavior based on negative peer feedback, while only 81.5 percent of residents said they’d change their behavior based on positive peer feedback.
• Although more than 85 percent of residents said they consider peer feedback helpful in assessing such competencies as communication skills and professionalism, only 59 percent reported that it benefited their training.
• Participants found peer evaluations most helpful in assessing work ethics, team-building and interpersonal skills. They found peer evaluations least helpful in assessing medical knowledge.

Contrary to a previous study that suggests residents may not feel responsible for their colleagues’ performance or find peer reviews helpful, residents in this study “regarded the ability to engage in peer-to-peer feedback delivery as a critical professional skill requiring professional accountability and interdependence that would benefit them in their future careers,” the study authors said.

In the focus group discussions, the need for more structure in the peer assessment process garnered the most attention from residents. Instead of conducting online peer assessments, residents generally agreed that “frequent, informal verbal feedback would allow them to make more meaningful practice-based changes,” according to the study.

Some barriers residents identified to providing quality feedback included:

• A lack of time to provide substantial feedback
• Concerns about feedback negatively affecting interpersonal relationships
• A fear of providing “uphill” feedback to senior or chief residents
• Concerns about guaranteed anonymity, especially in smaller institutions

Solutions residents identified for programs to accomplish this included:

• Structurally integrating peer evaluations into the formative feedback process that typically is provided only by attending physicians
• Tailoring peer feedback goals and evaluation content to residents’ specific years in training and rotations
• Offering residency preparatory training on how to adequately evaluate peers
• Forming a residency committee of peers (not faculty) to establish specific guidelines, goals and objectives for peer evaluations
• Prioritizing more time for peer feedback to help cultivate a “feedback culture” for self-improvement among residents

Although the study authors acknowledged the constraints of using such a small sample of residents, they noted that the insights residents shared can help “residency programs interested in refining an existing approach or initiating a peer-to-peer feedback process.”