'Playing the game': How do surgical trainees seek feedback using workplace-based assessment?

Area of Science:

• Medical Education
• Surgical Training
• Healthcare Professional Development

Background:

• Feedback is crucial for trainee development, yet challenges exist in its delivery and reception.
• Workplace-based assessments (WBAs) are integral to surgical training, but their influence on feedback-seeking behaviors is under-explored.

Purpose of the Study:

• To investigate how workplace-based assessments (WBAs) shape the feedback-seeking behaviors and interactions of surgical trainees.
• To understand the factors influencing trainees' decisions to seek feedback within and outside of formal assessment contexts.

Main Methods:

• Qualitative study employing template analysis of 10 focus groups with 42 UK surgical trainees.
• Data analysis incorporated a priori themes and emergent themes, with rigorous coding by three researchers.
• Themes were visually linked to facilitate critical exploration of feedback-seeking dynamics.

Main Results:

• Trainees' perceptions of WBAs (learning tool vs. test) and trainer relationships influenced feedback-seeking strategies.
• Perceiving WBAs as a test prompted trainees to seek positive feedback and avoid negative feedback ('playing the game').
• Negative feedback, often sought outside WBAs, was more impactful for practice change than positive feedback.

Conclusions:

• Trainee perceptions of WBAs and their relationship with trainers dictate feedback-seeking behaviors.
• The drive to 'play the game' by seeking positive feedback is linked to viewing WBAs as assessments.
• Negative feedback, crucial for clinical practice improvement, is often pursued independently of WBAs.