Background Standard evaluations of faculty teaching are limited by a lack of specificity and the ceiling and halo effects.
Objective To illustrate the richness of specific feedback generated by trainees using a novel research tool, the Nominal-Group Technique (NGT).
Methods Medical students and residents rotating on the inpatient medicine service participated in end of rotation NGTs to elicit evaluative feedback on their attending physicians. NGT is a structured process utilized in a group setting to elicit responses to a specific question. The question placed to the team members was What are the specific teaching behaviors of attending physicians that foster learning by adding to the knowledge, attitudes, or skills that define competency as a physician? Using a "round-robin " nomination strategy to elicit responses from individual participants, a comprehensive list of behaviors was generated. Next, team members independently selected responses from the list that reflected from their perspective their attending's most effective teaching behaviors and those with room for improvement. The data were returned to attendings as feedback. To illustrate the richness of the feedback generated via NGT, we present a qualitative analysis of the team results of a single physician on two consecutive ward months.
Results A total of 119 students and residents performed 42 NGT evaluations of 23 attending physicians. For our sample attending at baseline, team members identified the most effective teaching behaviors as asking questions concerning clinical decision making, teaching from past experience, and evaluating team members mid-month. Areas in which improvement was felt possible included being more decisive, giving short talks on pertinent patient topics, and teaching how one educates patients. Two months after receiving feedback, the attending's new team indicated that two of the behaviors previously identified as having room for improvement were now considered to be among his three most effective teaching behaviors: having confidence in decision making, setting aside time for group talks, and being approachable and willing to answer questions.
Conclusions In overcoming the ceiling and halo effects, NGT provides faculty with personalized behavioral feedback often missed with current evaluation tools.
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