Multisource feedback in GP training

Multisource feedback (MSF) is a key part of the workplace-based assessment. Dr Prashini Naidoo explains how it should it work in practice and what trainees can learn from the process.

The RCGP describes multisource feedback (MSF) as a means of collecting colleagues’ opinions on the trainee's clinical performance (eg diagnosis, management) and professional behaviour (eg being caring, respectful, a good communicator).

Trainees reflect on the collated data to become consciously aware of their areas of strength and to uncover areas for development.

Can MSF make you a better doctor?

A systematic review of eight studies looked at whether MSF actually affects doctors’ education and performance.1 The research found that most doctors felt that MSF had educational value. Some studies showed that MSF can bring about a change in doctors' performance; others did not.

Interestingly, some junior doctors and surgeons displayed little willingness to change in response to multisource feedback, whereas GPs seemed more prepared to initiate change. A survey of 113 GPs showed that 61% had either made practice changes or were planning to make them in response to their multisource feedback.

Performance changes were more likely to occur when feedback was credible and accurate or when coaching was provided to help subjects identify their strengths and weaknesses.

How should MSF work in training?

Trainees should agree dates to conduct the MSF with their trainer and when to discuss feedback. Trainees in secondary care need MSF from five clinicians with different job titles.

Those in primary care need five clinicians (mainly GPs) and five non-clinicians. All respondents should have observed you in the workplace. The supervisor or trainer should know who you have asked to take part.

The RCGP says it is good practice to get opinions from as many different colleagues as possible.

Two cycles of MSF are mandatory during ST1 and ST3 years, none are mandatory during ST2.

An example MSF

Read the MSF summary for an ST1 doctor below. As you read through, ask yourself the following questions:

  • Did the trainee choose the correct respondents?
  • Was the trainee’s educational supervisor (ES) informed which colleagues he'd asked to take part? Did the ES contact a sample of respondents to check that they did contribute to the MSF?
  • Did clinicians answer both sections of the MSF questionnaire and non-clinicians just answer the first section?
  • Did the trainee try to obtain opinions from as many different colleagues as possible?
  • Did the trainee have a feedback interview and an opportunity to reflect on the results?
  • Was this discussion and the resulting action plan recorded as a ‘professional conversation’ in the learning log?

Form submission analysis for trainee (ST1)

Comment from supervisor:
As we discussed by email, this is a very encouraging MSF. Well done. Your communication and team working do not go unnoticed. Your colleagues value your clinical knowledge, professionalism,  approachability and kind manner. They notice that you keep up to date and also share your knowledge.

The five colleagues who provided feedback included one doctor, one nurse, one pharmacist, one allied health professional and one administrator. Unfortunately, for an ST1 MSF to count as one of the mandated assessments, you need responses from five clinicians; you have four.

Only two respondents completed the section overall clinical performance (table 2). You need all five respondents to complete both sections of the form (professional behaviour and clinical performance). I need to apologise for shutting down the MSF so early, that is after five people responded before checking that all five were clinicians. I had assumed that you only contacted clinicians, as per RCGP guidance.

When you re-do the MSF, please send me the email addresses of colleagues you approach (perhaps you can cc me on your email invites to them) so that I can contact a sample. The Bradford VTS website has a very good MSF letter-invite that you can email to colleagues.2 By cc'ing me, I can also check that you are sampling correctly and perhaps contact you (or them) if clinicians fail to complete both sections of the form.

When the new MSF is collated, do you still prefer that I email the results to you? Once again, this is a great MSF, but unfortunately it needs to be repeated to comply with RCGP guidance.

MSF on professional behaviour

Please provide your assessment of this doctor's overall professional behaviour
Selection Number of times rated Your peers
Very poor 0 1317
Poor 0 1333
Fair 0 12959
Good 0 82628
Very good 1 265669
Excellent 3 592316
Outstanding 1 223290
Average rating 6 5.78
Table 1: 5 responses

Highlights in performance (areas to be commended):

  • Well respected. Much liked by patients and colleagues.
  • Makes time for the patients, showing respect and no prejudice.
  • He is a pleasure to work with. Always courteous, kind and very approachable.
  • He knows his patients very well and is well informed.
  • He is a collaborative and supportive colleague. works consistently to complete work and is happy to cover colleagues.
  • A very good doctor. He is the first colleague I would go to for advice or guidance on anything clinical.
  • He sets very high standards and is a pleasure to work with.

Possible suggested areas for development in performance:   

  • To be more vocal in a powerful multidisciplinary team.Please provide your assessment of this doctor's overall clinical performance.

MSF on clinical performance

Please provide your assessment of this doctor's overall clinical performance
Selection Number of times rated Your peers
Very poor 0 645
Poor 0 1360
Fair 0 12649
Good 0 92329
Very good 1 263686
Excellent 1 378017
Outstanding 0 94726
Average rating 5.5 5.53
Table 2: 2 responses

Highlights in performance (areas to be commended):

  • Good at providing evidence based medicine for his patients.
  • Comfortable presenting to the team.

Possible suggested areas for development in performance:

  • Continue developing clinical examination skills.

Reflection on the feedback

When this trainee writes his 'professional conversation' learning log, he needs to reflect on:

  • the positive outcomes
  • the learning needs
  • based on the feedback, what specific behaviour(s) would he like to change?
  • what learning does he need to undertake to help him make these changes?
  • how could these changes improve patient care?

When he describes what happened, he should also comment on how he felt about the feedback and the process.

He should also discuss how undertaking the MSF helped his development as a GP. He should explore what was good or bad about the experience and whether the MSF made him reconsider certain values and beliefs.

Most importantly, he should outline what new learning needs he identified and propose learning activities to address them.

  • Dr Naidoo is a GP trainer in Oxford. She has written three books on how to pass the CSA. The latest book CSA Practice Cases for the MRCGP Paperback was published in Jan 2016.

References

  1. Miller, A. (2010). Impact of workplace based assessment on doctors’ education and performance: a systematic review. BMJ 2010; 341:c5064
  2. http://www.bradfordvts.co.uk/mrcgp/msf/

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