O3210: Improving PICU Fellow Feedback

Background: Delivering formative feedback in a high-quality, consistent, and constructive manner throughout fellowship training is imperative for the development of future intensivists and ultimately enhances patient care. The balance of providing fast-paced, complex patient care and educational best practices within the Pediatric Intensive Care Unit (PICU) can pose a significant challenge when allocating time and energy to provide feedback. However, the high-stakes environment of the PICU underscores the importance of providing high-quality formative feedback to fellows.

Our goal was to transform the culture within our PICU by establishing an environment that fosters feedback. This included creating a deliberate space for feedback, ensuring accountability between fellows and faculty, and equipping faculty with tools to improve the feedback being delivered. We aimed to achieve an increase in our feedback incidence rate to 50% by the end of the academic year 2023-24.

Methods: Initial baseline data for faculty providing trainees feedback was collected for the 2022-2023 academic year. After evaluating this data for the incidence and quality of feedback in the PICU fellowship, we implemented three interventions throughout the 2023-2024 academic year. All data was collected via REDCap, an electronic database, to track feedback occurrence and content. New interventions to aid in feedback culture transformation were implemented quarterly.

In Quarter 1, faculty and fellows were prompted to set a time and place to provide feedback at the onset of the week, utilize a structured feedback system, and record the feedback provided in the database. In Quarter 2, feedback data was distributed at faculty meetings and high-quality, consistent, feedback was encouraged. In Quarter 3, a workshop on how to deliver actionable and specific feedback, with a focus on the providing formative over summative assessments, was available for all PICU faculty.

Following each intervention cycle, a study member analyzed feedback for incidence and whether the content of the feedback response was specific and/or actionable.

Results: For the academic year 2022-2023, feedback was provided and recorded in 10 out of 58 (17.2%) fellow-faculty pairs. Of that feedback, 53.3% (16/30 responses) was specific and 30% (9/30 responses) was actionable. At the end of Quarter 1 of the 2023-2024 academic year, the feedback incidence improved to 46.7% (14/30). Of that feedback, 71.4% (30/42 responses) was specific and 64.3% (27/42 responses) was actionable.

Conclusion: Setting an intentional framework for feedback between faculty and trainees increased the incidence and quality of feedback delivered. This improvement occurred by changing the structure and emphasis on feedback. We hope to sustain this improvement with continued education and culture transformation, leading to an improved experience of trainee education and overall patient care.