47 Collecting patient feedback on trainee skills Methods This study was part of a university hospital project stimulating the development of training innovations. We performed a mixed methods study. Patients rated residents’ skills using validated measures. Quantitative questionnaire data were used to test whether skills ratings differed between residents and whether those ratings improved over time during this pilot project. Participating residents were interviewed afterward. Qualitative interview data were used to deepen our understanding of residents’ views on SDM, reflexivity skills, and patient feedback. Participants and setting The study was performed in the Ob/Gyn department of a university hospital in the eastern part of the Netherlands. Four of the researchers either worked in this department or had worked there before; two of them as previous residents (LS, JA) and the others as the past (DB) and current (AB) head tutor of Ob/Gyn medical specialty training. Due to local training structure, all third- and fourth-year Ob/Gyn residents within the region are trained within this department. These residents served as a homogeneous sample for this study. All third- and fourth-year residents working within the department during the study period were requested to participate. Measures For this study’s quantitative part, a six-item questionnaire was designed to collect patient feedback. The questionnaire incorporated two existing surveys: CollaboRATE and the Net Promoter Score. CollaboRATE is a validated three-item questionnaire measuring the degree of SDM in physician consultations. It assesses three core SDM principles: ‘information and explanation about health issues’, ‘elicitation of patient preferences’ and ‘integration of patient preferences into decisions. [17, 18] The Net Promoter Score - also known as Friends and Family test - is a single question in which patients indicate whether they would recommend their doctor to others. [19, 20] These four items were measured on a 5-point Likert scale, ranging from 0 - ‘no effort was made’ or ‘very unlikely’, to 4 - ‘every effort was made’ or ‘very likely’. The study questionnaire was completed with two open-ended questions, where patients could write down positive and negative remarks. Both the members of an existing patient panel and the participating residents commented on the first draft of the questionnaire, the invitation email, and the interface of the online questionnaire. Feedback was used to refine the wording of these items where possible. The patient questionnaire is displayed in Table 1. Next, qualitative data were gathered through semi-structured interviews with residents. Participants received questions about SDM, their experiences with the pilot, and the usefulness of patient feedback in general and in training. The interview guide is provided in the supplementary file. 3
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