#KeyLIMEPodcast 202: Peer pressure proves positive performance

Are audit and feedback interventions for physicians strengthened by social interaction? Read on, and check out the podcast here.


KeyLIME Session 202:

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Cooke et al. How do physicians behave when they participate in audit and feedback activities in a group with their peers? Implement Sci. 2018 Jul 31;13(1):104


Reviewer: Jonathan Sherbino (@sherbino)


Let’s admit that we’re a little hypocritical.  I am.  I talk a good game about the importance of feedback and growth mindset.  I truly believe in these concepts.  And I work to provide feedback to residents and encourage them to develop a growth mindset.  But… when it comes to me… I’m not great at either.  With physician dashboards all the rage, I have developed an impressive, no fantastical, ability to justify, refute, and ignore any metric that does not align or massage my fragile professional ego.  Why should clinician educators care about this problem with me… and with other clinicians?  Well,  our current model of performance improvement and CPD (I think) is fatally flawed.  It allows either the physician to conduct the self -assessment (rewind the KeyLIME tapes for the numerous rants on the problems with self-assessment) or the physician to individually process external data.

The Cochrane review on audit and feedback demonstrates a very weak effect.  I suspect it’s a function of process the data individually.  Enter a group process.  If you want to understand how group-based CPD using ‘objective’ performance metrics changes practice, read on!


“This study was focused on exploring physician behaviors during the AGF [audit and group feedback] sessions and how these contributed to interaction during the session and ultimately to the discussion of change and implementation strategies by the physician groups.”

Key Points on Method

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  • Inductive thematic analysis of verbatim transcripts of six AGF sessions of Calgary branch of Alberta Physician Learning Program 2015-16
    • Two independent coders
    • Team discussion of themes and to develop a code
    • Independent recoding of all transcripts
    • Consensus process

Key Outcomes

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Key Conclusions

The authors conclude…

“…we offer one primary contribution to the AF literature: a conceptual model that describes the behaviors of physicians who receive performance feedback in a group setting with their peers. This model shows that physicians move through a discrete series of reactions and behaviors during AF in a group setting and that the presence of peers during the sessions leads to change planning.”


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