Feedback on Feedback: Faculty Interventions Improve Narrative Feedback in Resident Assessments

EM residents perceive a lack of quality feedback on workplace-based assessments (WBAs). Faculty development to address this problem often summarizes best practices without providing targeted feedback to individual faculty. The purpose of this study is to examine the impact of individual feedback to faculty on the quality of their narrative assessments of residents. We hypothesize providing this targeted intervention will increase the quality of feedback while decreasing the quantity of resident WBAs.

This prospective interventional study took place at a single academic institution from July 2023 to June 2025. Narrative comments included in WBAs were coded as Actionable with Guidance (AwG), Actionable without Guidance (AwoG), or Nonactionable (NA). Baseline data were collected from July 2023 to June 2024. Starting July 2024, quarterly metrics showing the individual distribution of assessments using the AwG, AwoG, and NA scale; distribution across all faculty; and exemplar feedback examples were provided to each faculty. Coding of narrative comments continued through July 2025. Descriptive statistics and Chi-square analyses were performed.

A total of 1523 narrative comments completed by 46 faculty were included in our analysis. Pre-intervention, feedback was 49.6% AwG, 32.5% AwoG, and 17.9% NA. Post-intervention, feedback was 66.5% AwG, 22.2% AwoG, and 11.3% NA. The distribution of these ratings was significantly different between years, X2 (2, N=1523)=44.7, p<0.01. The baseline number of WBAs per resident per year was 19.5, increasing to 22.8 post-intervention.

A targeted intervention providing individualized faculty feedback on their narrative assessments of residents increases the quality and quantity of resident WBAs. Future directions include identification and analysis of barriers to high-quality narrative feedback.