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J Surg Educ. 2017 Nov - Dec;74(6):e81-e87. doi: 10.1016/j.jsurg.2017.10.001.

Quality of Operative Performance Feedback Given to Thoracic Surgery Residents Using an App-Based System.

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Department of Surgery, Northwestern University, Chicago, Illinois.
Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
Department of Surgery, University of Kentucky, Lexington, Kentucky.
Department of Surgery, Northwestern University, Chicago, Illinois. Electronic address:



Residents frequently report inadequate feedback both in quantity and quality. The study evaluates the quality of faculty feedback about operative performance given using an app-based system.


Residents requested operative performance evaluation from faculty on a real-time basis using the "Zwisch Me!!" mobile application which allows faculty to provide brief written feedback. Qualitative analysis of feedback was performed using grounded theory.


The 7 academic medical centers with thoracic surgery training programs.


Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty.


Residents (n = 33) at 7 institutions submitted a total of 596 evaluations to faculty (n = 48). Faculty acknowledged the evaluation request in 476 cases (80%) and in 350 cases (74%) provided written feedback. Initial open coding generated 12 categories of feedback type. We identified 3 overarching themes. The first theme was the tone of the feedback. Encouraging elements were identified in 162 comments (46%) and corrective elements in 230 (65%). The second theme was the topic of the feedback. Surgical technique was the most common category at 148 comments (42.2%) followed by preparation for case (n = 69, 19.7%). The final theme was the specificity of the feedback. Just over half of comments (n = 190, 54.3%) contained specific feedback, which could be applied to future cases. However, 51 comments (14.6%) contained no useful information for the learners.


An app-based system resulted in thoracic surgery residents receiving identifiable feedback in a high proportion of cases. In over half of comments the feedback was specific enough to allow improvement. Feedback was better quality when addressing error prevention and surgical technique but was less useful when addressing communication, flow of the case, and assisting. Faculty development around feedback should focus on making feedback specific and actionable, avoiding case descriptions, or simple platitudes.


Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; feedback; qualitative study; surgical education

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