Using Peer Feedback to Promote Clinical Excellence in Hospital Medicine

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Division of Hospital Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California, San Francisco, CA, USA; 2Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA.

Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians. KEY WORDS: peer feedback; professional development; clinical excellence; hospital medicine J Gen Intern Med DOI: 10.1007/s11606-020-06235-w © Society of General Internal Medicine 2020

CLINICAL CASE

An early-career hospitalist is called to her annual meeting with the Chief of Service. She feels like her first year on faculty has been a steep learning curve but has yet to receive much reinforcing or corrective feedback regarding her clinical care, so she assumes she is performing as expected. The Chief congratulates her that her length of stay and readmission metrics are within the expected range for the hospitalist group but mentions having received feedback over the past few months from hospitalist colleagues that her handoffs are often not updated with the most accurate clinical information. When she asks for more details regarding these concerns, the Chief states that unfortunately that is all they know about the issue. Leaving the meeting, the hospitalist is embarrassed and unsure of how to improve her clinical aptitude. She yearns for more timely and structured feedback to proactively improve her clinical performance.

Received May 4, 2020 Accepted September 10, 2020

INTRODUCTION

Hospital medicine is the nation’s fastest growing specialty with more than 50,000 clinicians currently practicing in the USA.1 In both community and academic programs, hospitalists provide a significant amount of direct clinical care and clinical oversight.1 Many hospitalists begin practice immediately following residency training, where they subsequently develop and refine nascent practice patterns on the job. With an increasing presence in the acute care setting and demonstrated higher mortality rates for patients cared for by earlycareer hospitalists,2 tools that foster and improve clinical excellence are critically important. Clinical excellence can be defined as the practices, attitudes, skills, and knowledge of an expert clinician that lead to delivering compassionate and informed patient care.3, 4 Priori