Observing and Giving Feedback to Novice PGY-1s

In this new era of educational milestones and entrustable professional activities, residency programs have recognized the need to directly observe resident performance. In fact, there is little information about how often residents are observed, what procedures they perform early in training, and whether they receive feedback. Previous publications have addressed these issues exclusively through retrospective survey analyses. The purpose of this naturalistic point-of-care study was to answer the following questions about obstetrics/gynecology (OB/GYN) residents in their second month of training: what activities do residents report performing, how often are they observed and who observes them, how often do they receive feedback and what is their perception of its usefulness, and does the time of shift affect the frequency of observation and feedback?

Nine of 10 first-year OB/GYN residents at George Washington University Hospital participated in a month-long study during their second month of training. Based on point-of-care experiences, participants prospectively recorded the time of shift, activities performed, the person who observed them, whether they received feedback, and whether it was perceived as helpful.

First-year OB/GYN residents (postgraduate year 1 [PGY-1]) perform a variety of activities early in training while being observed by senior residents, nurses, and attending physicians 70% of the time. Residents commented that feedback was helpful almost every time they received it, regardless of who provided the feedback. There were no significant differences in the quantity of observations and feedback received between day and night shifts; however, nurses and senior residents were most likely to observe residents during night shifts.

In this naturalistic pilot study, OB/GYN residents reported performing various procedures in their second month of training, with some observations from faculty, senior residents, and nurses. Feedback, as defined in the study, is an important aspect of their early training, although it is not reported with each patient encounter. This pilot study raises critical issues that need further study, such as the following: What should be the gold standard for observing residents around a particular activity? Where should the bar be set for types and numbers of procedures that residents perform early on in training, either with patients or in simulations? What is an acceptable feedback rate around patient encounters? Should we not consider training nurses and senior residents to deliver effective feedback to residents as part of a 360-degree process, because many trainees were observed most frequently by these members of the medical team?