246 - Meaningful Clinical Performance Feedback and Physician Well-Being

Poster Number: 246
Publication Number: 246.418

Emily Levoy, Stanford University, Menlo Park, CA, United States; Stacie Vilendrer, Stanford University School of Medicine, Menlo Park, CA, United States; Rebecca Dang, Stanford University, Palo Alto, CA, United States; Annette Nasr, Stanford University School of Medicine, Palo Alto, CA, United States; Jacklyn Luu, Stanford University School of Medicine, Stanford, CA, United States; Daniel S. Tawfik, Stanford University School of Medicine, Palo Alto, CA, United States; Tait Shanafelt, Stanford University School of Medicine, STANFORD, CA, United States

Background: Clinical performance feedback for physicians can improve both quality of care and promote faculty development and well-being, yet may also decrease job satisfaction if it is focused on topics deemed unimportant or is delivered in sub-optimal manner. Providing feedback in areas that physicians deem important has been identified as a best practice to promote improved performance, but there is a paucity of literature identifying which feedback physicians most value. More research is also needed on how feedback content and delivery may impact physician well-being.

Objective: This project aimed to identify the clinical performance feedback domains most important to physicians and to determine whether these aligned with the domains in which they received feedback. The project also aimed to determine how variation in feedback content and delivery relates to physician well-being.

Design/Methods: This qualitative study used semi-structured interviews of 25 general pediatrics and general internal medicine outpatient and inpatient physicians chosen by a maximum variation sampling technique to reflect a diversity of perspectives. Interview transcripts were coded using inductive-deductive thematic analysis through periodic consensus discussions by the research team guided by the Clinical Performance Intervention Theory framework.

Results: 25 interviews from faculty physicians (Table 1) identified clinical knowledge, quality metrics, patient experience, interpersonal skills and operational skills as emergent feedback domains. Patient experience and interpersonal skills were mentioned by the majority of participants when describing the skills they hope to embody as a physician, while operational skills was rarely mentioned (only mentioned by 1/25 participants). The interview data reflected that many physicians only received feedback in operational skills or no formal feedback at all. The mechanism of feedback also played a role in whether feedback was perceived as meaningful. Physicians desired coaching, direct observation and multi-source feedback to better understand their clinical performance but preferred group-level feedback in domains over which they had less direct control, such as quality metrics and operations. Overall, physicians felt that feedback supported well-being if its intention was to promote professional growth, as demonstrated by its focus on relevant, attainable goals and its inclusion of praise, specificity, clear context, and non-punitive delivery.Conclusion(s): Restructuring clinical performance feedback for physicians has the potential to improve quality of care and physician well-being.
Emily Levoy CVEmily Levoy MD CV .pdf
Figure 1: Clinical Performance Feedback Well-Being ModelFeedback promoted well-being if it was perceived as intending to promote professional growth, as demonstrated by goal-setting with relevant, attainable goals with a component of praise, by collecting and analyzing data for feedback in a way that provides specificity and context, and by delivering feedback in a non-punitive way. The impact of feedback, and lack thereof, on well-being was additionally mitigated by recipient variables of feedback expectations and personal confidence in one’s ability to self-assess and by context variables of supportiveness of the clinical environment.