Narrative Feedback Quantity and Quality in Entrustable Professional Activities for General Surgery Residents

We explored the frequency of narrative feedback within Entrustable Professional Activity (EPA) evaluations for how often narrative feedback occurs, the content of the narrative feedback, and whether the feedback is actionable.

Deidentified EPA evaluations were analyzed for inclusion of narrative feedback. The inclusion of narrative feedback was assessed for clinical setting and resident PGY level. A combined inductive and deductive qualitative coding approach was used to evaluate the content of the narrative feedback and determine if the feedback was actionable. Actionable feedback was detailed and clear enough to delineate areas for improvement or highlight specific things that were done well.

Two large, academic general surgery residency programs.

All general surgery resident EPA evaluations completed by faculty at both institutions.

Overall, 4859 EPA evaluations were completed at the 2 institutions, and narrative feedback was present in 3267 (67.2%). PGY4 and PGY5 residents had the greatest proportion of narrative feedback (77.8% and 71.8%). Narrative feedback was most often provided for intraoperative clinical encounters (71%). Frequent themes from the content of the narrative feedback were clinical decision-making, open or laparoscopic/robotic dissection technique, retraction, tissue handling, tissue planes, case progression, and staff communication. Most feedback was positive (88.8%). Only 26.8% (876/3267) of the feedback was considered actionable, with the greatest proportion of actionable feedback in intraoperative evaluations (28.8%). PGY4 residents had the most actionable feedback (29.1%).

The majority of EPA evaluations included narrative feedback, but only a small portion of that feedback was actionable. Feedback often focused on elements of technical skill, but there was some inclusion of nontechnical feedback. Ongoing efforts are needed to further promote narrative feedback within EPA evaluations and ensure that all feedback provided is actionable to allow for resident performance improvement.