Ask-Tell-Ask with Bidirectional Feedback Improves Feedback Culture

Objective

The authors sought to assess whether an Ask-Tell-Ask feedback model augmented with bidirectional feedback improves perception of feedback.

Methods

Implementation occurred on an inpatient psychiatry unit at University of North Carolina (UNC) Hospitals from July 2022 to June 2023 among attending and resident physicians and medical students. Attending physicians were educated on the Ask-Tell-Ask model and encouraged to hold weekly bidirectional feedback sessions with trainees. Surveys containing scales and free-text response were distributed by email before and after rotations to assess perception of feedback: if feedback was clearly stated, occurred on a predictable basis, included actionable goals, and fostered bidirectional feedback with attendings. For statistical analysis, survey responses were assigned numerical values of 1 (strongly disagree) to 5 (strongly agree). Differences between mean numerical correlates of responses from pre-rotation and post-rotation surveys were analyzed with unpaired t-tests; p < 0.05 indicated statistical significance. Authors independently developed themes from free-text responses, which were consolidated with themes developed by all authors.

Results

Mean ratings to survey items universally improved following the intervention; all p < 0.0001 and statistically significant. Pre-rotation, feedback culture was described as constrained, fraught, non-actionable, inconsistent, improving, and hierarchical. Post-rotation, the feedback culture within the UNC Department of Psychiatry was described as constructive, consistent, improving, strength-based, approachable, and nonhierarchical.

Conclusions

An Ask-Tell-Ask feedback model with an added emphasis on giving and receiving feedback significantly improves perception of feedback and feedback culture.