"O wad some Power the giftie gie us to see oursels as ithers see us!   It wad frae mony a blunder free us, an' foolish notion."   Rabbie Burns

"He who knows others is learned; he who knows himself is wise."   Lao-tzu

Compulsory revalidation begins for British medical doctors on the 3rd December this year.  As the GMC (General Medical Council) points out "Revalidation will be our new way of regulating licensed doctors that aims to give extra confidence to patients that their doctors are up to date and fit to practise.  Licensed doctors will have to revalidate, usually every five years, by having regular appraisals that are based on our core guidance for doctors, Good Medical Practice.  These regular checks on doctors will be a world leading system that will help improve the quality of care received by patients."  As doctors, we will all have annual appraisals and will be expected to bring supporting materials to these appraisals.  These materials will include both formal feedback from our patients and from our colleagues.  So, at least once in every five year revalidation cycle, all UK doctors will be expected to "seek feedback from colleagues and patients and review and act upon that feedback as appropriate ... The purpose of the exercise is to provide you with information about your work through the eyes of those you work with and treat, and is intended to help to inform further development."  The number of colleagues and patients who should be asked to contribute to the feedback will vary with the assessment methods being used.  With the tools provided by the GMC, it is recommended that each doctor bases their feedback on questionnaires completed by at least 15 colleagues and at least 34 patients. 

Fascinating ... so as a British doctor, I won't be allowed to continue to practise unless I regularly receive and act on "multi-source feedback" (MSF) from my colleagues and patients.  Parallel forms of compulsory multi-source or 360 degree feedback are coming or have already come for many other doctors and health professionals around the world.  And people in other work environments have frequently been subject to this kind of feedback as part of regular appraisals for years.  Obviously there's a large body of expert opinion that considers feedback is of great importance.  In yesterday's post "Five recent research studies on the worrying variability both in psychotherapist effectiveness and also in willingness to change", I argued strongly for the importance of more formal feedback systems for psychotherapists too. 

So all's rosy in the garden, mm?  Well maybe not.  I had lunch recently with a professor of general practice, an expert in primary health care in this country, and they certainly weren't raving about how multi-source feedback was going to be of definite benefit to doctors.  I'm confident it could be of real value, but like most things that can be powerful, it can also damage.  On balance, at the moment, it looks as though feedback is somewhat beneficial.  This year's Cochrane review, the Rolls Royce of evidence-based medicine, concluded in the paper "Audit and feedback: effects on professional practice and healthcare outcomes" that "Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback."  And this very thorough review of relevant research also stated "feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan."

I think the weasel phrase here is that "On balance feedback is somewhat beneficial".  The evidence suggests that this finding is the sum of some feedback being of considerable help, some making no difference, and some being actively damaging.  It's very important that we learn how feedback can be made as helpful as possible. Multi-source feedback looks here to stay and, I think, rightly so.   We really do need to be cautious of relying solely on our own self-assessment.  Overeem & colleagues in another of this year's papers about feedback, "Evaluation of physicians' professional performance: an iterative development and validation study of multisource feedback instruments" reported that "The study demonstrated that the three MSF instruments produced reliable and valid data for evaluating physicians' professional performance in the Netherlands. Scores from peers, co-workers and patients were not correlated with self-evaluations."  Mm ... note that "Self-ratings were not correlated with peer, co-worker or patient ratings. However, ratings of peers, co-workers and patients were correlated."  Ouch!  I think Rabbie Burns had a point "O wad some Power the giftie gie us to see oursels as ithers see us!   It wad frae mony a blunder free us, an' foolish notion."  

In the next post in this series on feedback, I'll write about "Lessons from a personal multi-source feedback project" and then make "Some suggestions for giving & receiving helpful feedback".