"The Absence of Criticism Constitutes Sufficient Praise?" Development and Implementation of a "Feedback Team...

Feedback is essential for the assessment of competencies and addressing measures for improvement. It leads to greater satisfaction and maintains high-quality standards in healthcare delivery. Feedback is an integral part of medical education, but structured feedback is rare in surgical training. In Germany, postoperative feedback discussions take place regularly in only 12% of all surgeries. The aim of this study is therefore to improve feedback in surgical training by developing, implementing, and evaluating a feedback tool called "Feedback Team-Time-Out" and to assess the feedback culture before and after the introduction of this tool.

The feedback tool was developed in a stepwise, iterative process by an interdisciplinary team and is based on the WHO checklist. After the tool was developed, an exploratory pre-post intervention study was conducted in the Department of Visceral Surgery at Kiel University Hospital from February to September 2024 to assess the perioperative feedback culture before and after implementation of the tool. Questionnaires were used to assess the quantity, quality, and content of perioperative feedback, and the feedback tool was subsequently evaluated. The questionnaires were completed by both the trainees and the trainers.

Perioperative feedback was documented using questionnaires in 69% of all training procedures before the tool was introduced and in 86% after its introduction. Before the introduction of the tool, intraoperative feedback was given in 72.5% of procedures vs. in 87% after introduction, according to trainees (p = 0.064), and postoperative feedback in 31.4% vs. 42.6% (p = 0.234). According to the trainers, intraoperative feedback was provided to 82.2% of trainees in the pre-intervention phase (p = 0.085) and to 75% in the postintervention phase (p = 0.009). Preoperative discussion of the learning objective increased from 11.5% to 44.4% (p < 0.001) according to trainees and from 26.7% to 70.8% (p < 0.001) according to trainers. In the evaluation, trainers and trainees confirmed that the tool leads to more feedback in surgical training. The most common reasons given for not using the tool and not giving feedback in general were a lack of time, insufficient staffing, and the absence of structured workflows. In an effort to improve the feedback culture and surgical training in everyday surgical practice, both trainers and trainees expressed a desire for more time and the importance of feedback to be strengthened in everyday clinical practice.

Postoperative feedback is rarely given in surgical training. Introducing a feedback tool can be the first step to establish a surgical feedback culture and thereby improve surgical training and outcomes.