55 Collecting patient feedback on trainee skills low numbers are partially explained by individual residents’ working schedules, including differences in number of consultations with patients. The low response rates further reflect that responses might not be representative for all patients. Another limitation for representativeness is the fact that only patients with known email addresses were included in this study, although few patients had no known email address. Also, the study used a small convenience sample, and researchers knew the participating residents in person. However, researchers minimized bias by individually analyzing interview results, discussing codes between researchers, and using identity codes. Finally, patient scores were given to residents at three time points, with a maximum interval of 10 weeks between a patient’s visit and the resident receiving feedback. The lack of immediate feedback might have resulted in a lack of residents’ responsiveness to the feedback. Conclusion To the best of our knowledge, this is the first study that examines the use of patient feedback for evaluating residents’ SDM skills and reflexivity. Based on current study results, no definite conclusions can be drawn on whether patient feedback enhances reflexive practice and leads to subsequent changes in SDM performance. Interview results do suggest potential benefits of patient feedback, especially when reflexivity is encouraged or facilitated. Practice implications Collecting patient feedback and providing results should be performed at short intervals and combined with facilitated reflections. Supervisors should be trained in SDM and facilitating reflections with trainees. Future effect studies should test whether these alterations support residents’ development and subsequently reinforce behavior change. Funding: This work was supported by the Education and Training Region East Netherlands (OOR-ON), a cooperation of regional teaching hospitals. 3
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