694 - Feedback: A Journey from Avoidance to Coaching

Publication Number: 2677.694

Movicque King, University of Virginia School of Medicine, Louisa, VA, United States; Jaclyn Wiggins, University of Virginia School of Medicine, Charlottesville, VA, United States; Sarah Miller, UVA Childrens, Charlottesville, VA, United States; Cherise Brackett, WakeMed Children's Hospital WakeMed Health and Hospitals, Apex, NC, United States; Patricia N. Moran, West Virginia University Children's Hospital, Morgantown, WV, United States; Alix Paget-Brown, UVA Childrens, Charlottesville, VA, United States; Brooke D. Vergales, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Scarsdale, NY, United States; Santina Zanelli, University of Virginia, Charlottesville, VA, United States; Jennifer Burnsed, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Effective feedback is critical for trainee development but is often neglected in high-acuity settings such as the neonatal intensive care unit (NICU). Both faculty and fellows expressed concern that feedback was either not occurring or was ineffective when delivered. Inadequate feedback can impair learning, allow small mistakes to go uncorrected, and potentially lead to downstream clinical errors.

Objective: The aim of this project was to foster a culture shift from feedback avoidance to coaching by implementing a structured feedback process. Specifically, we aimed to increase the completion rate of weekly feedback sessions to >75% within three months of implementing the intervention.

Design/Methods: Faculty and fellows co-designed a structured feedback tool-"Feedback Cards"-which incorporated written goal setting and space for real-time observations. Prior to starting service, fellows defined two learning goals which were reviewed with the attending. Faculty and fellows met midweek and at week's end to review feedback aligned to those goals. Two faculty development workshops were also conducted to promote best practices in feedback delivery and reception. A p Chart was used to depict our data. Process Measure: Completion of feedback documentation during weekly service. Outcome Measures: Frequency of midweek and end-of-week feedback sessions; time from end of service week to feedback completion. Balancing Measure: Feasibility and faculty/fellow satisfaction with the intervention.

Results: Following implementation of the Feedback Card system, documented feedback between faculty and fellows increased from 54.8% to 85%. The average time to submit feedback decreased from 26.7 days to 1.5 days. Midweek feedback sessions, previously infrequent, were completed in 64% of service weeks. Fellow satisfaction with faculty feedback also improved, rising from 25% to 83.3%. These changes reflect greater consistency, timeliness, and acceptance of feedback practices after the intervention.

Conclusion(s): The use of structured feedback cards effectively increased the frequency and timeliness of feedback between faculty and fellows. It also shifted the culture from feedback in an email several weeks after service to an in-person discussion the last day of the service block. This intervention fostered a culture shift toward coaching and continuous learning. Sustaining this intervention will require continued emphasis on feedback literacy and system-wide buy-in. Future steps include formal evaluation of the quality of feedback delivered, integration into faculty onboarding, and exploration of scalability to other divisions.

Figure 1
Images of an example feedback card. A: Goals written by the fellow prior to the start of a service week. B: Written feedback on those goals and future goals written by the attending to facilitate a feedback conversation at the end of the week.

Figure 2
P chart showing our baseline data for feedback per month from August 2023 through June 2024 followed by our intervention data from September 2024 through March 2025.