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When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body-Mandated Peer Review.
Kori A LaDonna1, Lindsay Cowley2, Lesley Ananny3
1K.A. LaDonna is associate professor, Department of Innovation in Medical Education and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4738-0146 .
Summary
Physician feedback programs face a paradox: non-threatening feedback is often ignored, while threatening feedback hinders improvement. For high-performing physicians, feedforward may be more effective than traditional feedback for practice enhancement.
Area of Science:
- Medical Education
- Physician Performance
- Quality Improvement
Background:
- Effective physician performance relies on recognizing and addressing deficiencies through feedback.
- Physicians often lack access to meaningful guidance for improvement.
- Regulatory bodies mandate peer-facilitated practice enhancement programs to ensure quality.
Purpose of the Study:
- To explore physician engagement with feedback within regulatory-mandated peer review programs.
- To understand the perceived value and challenges of mandatory physician performance reviews.
Main Methods:
- Interviews with 30 physicians (reviewers and reviewees) from diverse specialties and career stages.
- Analysis of interview transcripts using a 3-stage coding process informed by constructivist grounded theory.
- Exploration of experiences with peer review in regulatory body-mandated programs.
Main Results:
- Physician perceptions of mandated peer review value were mixed, with anxiety often present due to regulatory oversight.
- Reviewers employed strategies aligned with the R2C2 feedback and coaching model to optimize interactions.
- Feedback often focused on minor adjustments ('tweaks') rather than substantial performance changes, limiting perceived learning value.
Conclusions:
- A paradox exists where non-threatening feedback is overlooked, yet threatening feedback is suboptimal for improvement.
- For physicians likely to perform well, managing expectations with feedforward may enhance practice improvement more effectively than feedback.
- Reconciling the tension between formative feedback intentions and perceived summative risks is crucial for effective physician development.
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