Peer-to-Peer Feedback Among Ambulance Clinicians A Cross-Sectional Study in the Out-of-Hospital Setting
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Abstract
Feedback is a well-researched and broad concept within healthcare, however, there is a contextual gap concerning peer-to-peer provision in the out-of-hospital environment. Current literature suggests that emergency ambulance clinicians most often receive feedback from their operational peers. Recent literature has identified that out-of-hospital feedback initiatives face long-term implementation and sustainability challenges. Further research is required to support the design and evaluation of feedback interventions.
This study aimed to describe how often emergency ambulance clinicians provided peer-to-peer feedback and its association with various factors.
A 10-question survey was distributed to London Ambulance Service members. Participants were eligible if they were registered or non-registered clinicians working on a frontline operational ambulance vehicle. A Fisher’s exact test using Monte Carlo simulations was performed using SPSS for statistical analysis. This research followed STROBE reporting guidelines for observational studies.
A total of 143 responses were included for analysis. Clinicians provided positive feedback more often than constructive or any other type of feedback. There was statistical significance between feedback provision and training (positive feedback p = 0.006), organizational culture (positive feedback p = 0.001), clinician comfort in provision (constructive feedback p = <0.001) and self-rated quality of feedback (any feedback p = <0.001). Factors such as experience, clinical grade or gender were not statistically significant.
Out-of-hospital emergency ambulance clinicians provided more positive peer-to-peer feedback and rarely provided no feedback. Clinicians should receive feedback training within curricula to increase exposure and engagement with feedback processes. Training should emphasize the role and benefits of constructive feedback. There is an organizational incentive to promote an honest feedback culture to facilitate learning opportunities. Clinicians felt comfortable and rated their quality of feedback as adequate. Standardizing feedback models in the out-of-hospital environment will reduce feedback inequalities.
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References
Avery, P., Thompson, C., & Cowburn, P. (2023). Training the trainers: Improving the quality of education delivered to paramedics through a simulation-debrief model. British Paramedic Journal, 7(4), 51–56. https://doi.org/10.29045/14784726.2023.3.7.4.51
Berger, S., Stalmeijer, R. E., Marty, A. P., & Berendonk, C. (2023). Exploring the impact of entrustable professional activities on feedback culture: A qualitative study of anesthesiology residents and attendings. Academic Medicine, 98(7), 836–843. https://doi.org/10.1097/acm.0000000000005188
Bing-You, R., Hayes, V., Varaklis, K., Trowbridge, R., Kemp, H., & McKelvy, D. (2017). Feedback for learners in medical education: What is known? A scoping review. Academic Medicine, 92(9), 1346–1354. https://doi.org/10.1097/acm.0000000000001578
Brown, B., Gude, W. T., Blakeman, T., van der Veer, S. N., Ivers, N., Francis, J. J., et al. (2019). Clinical performance feedback intervention theory (CP-FIT): A new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research. Implementation Science, 14(1), 40. https://doi.org/10.1186/s13012-019-0883-5
Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. BMJ, 337, a1961. https://doi.org/10.1136/bmj.a1961
Cash, R. E., Crowe, R. P., Rodriguez, S. A., & Panchal, A. R. (2017). Disparities in feedback provision to emergency medical services professionals. Prehospital Emergency Care, 21(6), 773–781. https://doi.org/10.1080/10903127.2017.1328547
Choi, B., Tsai, D., McGillivray, C. G., Amedee, C., Sarafin, J. A., & Silver, B. (2014). Hospital-directed feedback to emergency medical services improves prehospital performance. Stroke, 45(7), 2137–2140. https://doi.org/10.1161/STROKEAHA.114.005679
Eaton-Williams, P., Mold, F., & Magnusson, C. (2020a). Effective clinical feedback provision to ambulance clinicians: A literature review. Journal of Paramedic Practice, 12(3), 109–117. https://doi.org/10.12968/jpar.2020.12.3.109
Eaton-Williams, P., Mold, F., & Magnusson, C. (2020b). Exploring paramedic perceptions of feedback using a phenomenological approach. British Paramedic Journal, 5(1), 7–14. https://doi.org/10.29045/14784726.2020.06.5.1.7
Ende, J. (1983). Feedback in clinical medical education. JAMA, 250(6), 777–781. https://jamanetwork.com/journals/jama/article-abstract/387652
Gopal, D. P., Chetty, U., O'Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021). Implicit bias in healthcare: Clinical practice, research and decision making. Future Healthcare Journal, 8(1), 40–48. https://doi.org/10.7861/fhj.2020-0233
Health & Care Professions Council. (2023). The standards of proficiency for paramedics. https://www.hcpc-uk.org/standards/standards-of-proficiency/paramedics
Hunter, L. A. (2016). Debriefing and feedback in the current healthcare environment. Journal of Perinatal & Neonatal Nursing, 30(3), 174–178. https://doi.org/10.1097/jpn.0000000000000173
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., et al. (2012). Audit and feedback: Effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2012(6), CD000259. https://doi.org/10.1002/14651858.CD000259.pub3
Joyce, J., Cantillon, P., & Geoghegan, R. (2022). Peer feedback in graduate training: A phenomenological investigation of possibilities. Medical Teacher, 44(12), 1362–1367. https://doi.org/10.1080/0142159X.2022.2094229
Kelly, E., & Richards, J. B. (2019). Medical education: Giving feedback to doctors in training. BMJ, 366, l4523. https://doi.org/10.1136/bmj.l4523
Kim, H. Y. (2017). Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test. Restorative Dentistry & Endodontics, 42(2), 152–155. https://doi.org/10.5395/rde.2017.42.2.152
Landman, A. B., Spatz, E. S., Cherlin, E. J., Krumholz, H. M., Bradley, E. H., & Curry, L. A. (2013). Hospital collaboration with emergency medical services in the care of patients with acute myocardial infarction: Perspectives from key hospital staff. Annals of Emergency Medicine, 61(2), 185–195. https://doi.org/10.1016/j.annemergmed.2012.10.009
Lyon, R. M., Clarke, S., Milligan, D., & Clegg, G. R. (2012). Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland. Resuscitation, 83(1), 70–75. https://doi.org/10.1016/j.resuscitation.2011.07.016
McGuire, S. S., Luke, A., Klassen, A. B., Myers, L. A., Mullan, A. F., & Sztajnkrycer, M. D. (2021). It's time to talk to prehospital providers: Feedback disparities among ground-based emergency medical services providers and its impact on job satisfaction. Prehospital and Disaster Medicine, 36(4), 486–494. https://doi.org/10.1017/s1049023x21000601
Morrison, L., Cassidy, L., Welsford, M., & Chan, T. M. (2017). Clinical performance feedback to paramedics: What they receive and what they need. AEM Education and Training, 1(2), 87–97. https://doi.org/10.1002/aet2.10028
O'Connor, R. E., & Megargel, R. E. (1994). The effect of a quality improvement feedback loop on paramedic skills, charting, and behavior. Prehospital and Disaster Medicine, 9(1), 35–39. https://doi.org/10.1017/s1049023x00040814
Pendleton, D. (1984). The consultation: An approach to learning and teaching. Oxford University Press.
Patterson, P. D., Weaver, M. D., Weaver, S. J., Rosen, M. A., Todorova, G., Weingart, L. R., et al. (2012). Measuring teamwork and conflict among emergency medical technician personnel. Prehospital Emergency Care, 16(1), 98–108. https://doi.org/10.3109/10903127.2011.616260
Persse, D. E., Key, C. B., & Baldwin, J. B. (2002). The effect of a quality improvement feedback loop on paramedic-initiated nontransport of elderly patients. Prehospital Emergency Care, 6(1), 31–35. https://doi.org/10.1080/10903120290938742
Ramani, S., Könings, K. D., Ginsburg, S., & van der Vleuten, C. P. M. (2019). Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships. Medical Teacher, 41(6), 625–631. https://doi.org/10.1080/0142159x.2018.1432850
Ramani, S., Post, S. E., Könings, K., Mann, K., Katz, J. T., & van der Vleuten, C. (2017). “It's just not the culture”: A qualitative study exploring residents' perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine, 29(2), 153–161. https://doi.org/10.1080/10401334.2016.1244014
Sargeant, J. M., Mann, K. V., van der Vleuten, C. P., & Metsemakers, J. F. (2009). Reflection: A link between receiving and using assessment feedback. Advances in Health Sciences Education, 14(3), 399–410. https://doi.org/10.1007/s10459-008-9124-4
Stockdill, M., Hendricks, B., Barnett, M. D., Bakitas, M., & Harada, C. N. (2023). Peer observation of teaching: A feasible and effective method of physician faculty development. Gerontology & Geriatrics Education, 44(2), 261–273. https://doi.org/10.1080/02701960.2021.2019030
Stretton, P. (2020). The ‘just culture’: Why it is not just, and how it could be. British Journal of Nursing, 26(11), 304–310. https://doi.org/10.12968/bjhc.2020.0058
Tavares, W., Eppich, W., Cheng, A., Miller, S., Teunissen, P. W., Watling, C. J., et al. (2020). Learning conversations: An analysis of the theoretical roots and their manifestations of feedback and debriefing in medical education. Academic Medicine, 95(7), 1020–1025. https://doi.org/10.1097/acm.0000000000002932
Tham, T. C., Burr, B., & Boohan, M. (2017). Evaluation of feedback given to trainees in medical specialties. Clinical Medicine, 17(4), 303–306. https://doi.org/10.7861/clinmedicine.17-4-303
van de Ridder, J. M., McGaghie, W. C., Stokking, K. M., & ten Cate, O. T. (2015). Variables that affect the process and outcome of feedback, relevant for medical training: A meta-review. Medical Education, 49(7), 658–673. https://doi.org/10.1111/medu.12744
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ, 335(7624), 806–808. https://doi.org/10.1136/bmj.39335.541782.AD
Watling, C. J., & Ginsburg, S. (2019). Assessment, feedback and the alchemy of learning. Medical Education, 53(1), 76–85. https://doi.org/10.1111/medu.13645
Wilson, C., Howell, A.-M., Janes, G., & Benn, J. (2022). The role of feedback in emergency ambulance services: A qualitative interview study. BMC Health Services Research, 22(1), 296. https://doi.org/10.1186/s12913-022-07676-1
Wilson, C., Janes, G., Lawton, R., & Benn, J. (2023a). Feedback for emergency ambulance staff: A national review of current practice informed by realist evaluation methodology. Healthcare (Basel), 11(16). https://doi.org/10.3390/healthcare11162229
Wilson, C., Janes, G., Lawton, R., & Benn, J. (2023b). Types and effects of feedback for emergency ambulance staff: A systematic mixed studies review and meta-analysis. BMJ Quality & Safety, 32(10), 573–588. https://doi.org/10.1136/bmjqs-2022-015634