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Emerg Med J. 2007 August; 24(8): 574–575.
PMCID: PMC2660088

360° feedback for emergency physicians in Singapore

Abstract

Objectives

To determine if emergency physicians (EPs) are ready to accept 360° feedback, and agreement between self and colleagues' assessment in a 360° feedback for EPs.

Methods

Self‐administered questionnaire to determine acceptability of 360° feedback (n = 43). Each EP completed the Physician Achievement Review self‐assessment and approached five colleagues to complete an assessment for him/her.

Results

Thirty‐one responded: 77.4% preferred to select their appraisers, 90.3% wanted feedback to be confidential, 58.1% would share feedback with supervisors, but only 35.5% would link feedback to remuneration. Colleagues rated EPs' holistic management, humanistic aspects and patient communication, and professional relationship with colleagues as weak domains, weaknesses which EPs were only partially aware.

Conclusions

EPs would accept 360° feedback provided that they selected their appraisers and results were confidential. Colleagues reported that EPs were weak in “soft” and system skills.

The term “360° feedback” refers to an assessment process in which individuals evaluate themselves and receive feedback from supervisors, peers, subordinates and customers.1,2,3 The National Health Service has endorsed the 360° global rating for assessment of areas such as relating to and advocacy for patients, relating to colleagues, etc.4 In Singapore, 360° feedback has only been conducted for a small group of top physician‐managers. This study seeks to determine if emergency physicians (EPs) would accept such feedback and to determine agreement between self and colleagues' assessment in a 360° feedback for EPs.

Methods

Between 11 March 2005 and 13 April 2005, all EPs practising in public hospitals in Singapore were approached. An anonymous self‐administered questionnaire was used to determine readiness to accept 360° feedback. Each EP was requested to complete the Physician Achievement Review (PAR) Episodic Care Instrument from the College of Physicians and Surgeons of Alberta5 and to approach five colleagues whose opinion they valued to provide feedback. The PAR contained 30 behaviour statements (relating to clinical competence, holistic management of patients, humanistic aspects and patient communication, personal professional management and professional relationship with colleagues) and used a five point Likert rating scale (1 = among the worst, to 5 = among the best compared to other EPs). The study institution review board granted ethical approval.

Results

Forty‐three out of 50 EPs were approached. Thirty‐one (62% of all EPs in Singapore) responded (20 men, mean age 36 years). The majority (93.5%) agreed that colleagues were the best people to provide feedback, not just supervisors. If implemented, 77.4% preferred to choose their appraisers personally and 19.3% would object if appraisers were selected for them. The majority (90.3%) also wanted feedback to be confidential, 58.1% would share findings with a supervisor to improve performance, but only 35.5% would link feedback to remuneration.

All agreed that clinical competence was EPs' strongest domain. EPs rated holistic management as their weakest but colleagues rated EPs equally weak in three domains: humanistic aspects and patient communication, holistic management, and professional relationship with colleagues (table 11).

Table thumbnail
Table 1 Differences between self and colleagues' assessment of the domains

Discussion

Almost two‐thirds of EPs in Singapore were open to feedback from subordinates, peers and non‐physician colleagues, in contrast to the cardiothoracic residents reported by Higgins et al.6 However, this openness was conditional in that the EPs preferred to select their appraisers, they wanted the results to be confidential, and only half were prepared to share results with their supervisors. The EPs' preference to select their appraisers reflects perceived competence of appraisers7 and influences perceived validity and trustworthiness of the feedback. While some reports contended that results were not affected by how appraisers were chosen,1,2,3 clearly the acceptability of the results would be affected. The reluctance of the EPs to link feedback to remuneration supported the suggestion that 360° feedback was more suitable as a developmental and improvement tool, and should not be linked to remuneration.3,6,7,8

Colleagues perceived that EPs were weak in domains that encompass “soft” skills, weaknesses that the EPs were only partially aware. The national training committee needs to reinforce training for these “soft” skills to ensure that EPs will continue to improve in overall professional competence. Several authoritative medical organisations have endorsed 360° feedback as an appropriate method to assess humanistic and system skills, and professionalism,4,5,9 and in this study it has performed well.

Acknowledgements

The author is grateful to the College of Physicians and Surgeons of Alberta, Canada for use of the Physician Achievement Review. The author thanks the emergency physicians and their colleagues who participated in this study.

Abbreviations

EPs - emergency physicians

PAR - Physician Achievement Review

Footnotes

Competing interests: None declared

References

1. Antonioni D. Designing an effective 360‐degree feedback process. Organizational Dynamics . 1996;Autumn24–38.38
2. McCarthy A M, Garavan T N. 360° feedback processes: performance improvement and employee career development. Journal of European Industrial Training 2001. 255–32.32
3. King J. 360° Appraisal. BMJ 2002. 324195
4. National Health Service Professionals Appraisal for doctors in hospital practice: a handbook for NHS professionals (doctors) appraisers and appraisees. http://www.nhsprofessionals.nhs.uk/download/doctors‐services/2006Appraisalhandbook_Final.pdf
5. College of Physicians and Surgeons of Alberta, Canada Physician achievement review survey instruments: episodic care instruments. http://www.par‐program.org/PAR‐Inst.htm
6. Higgins R S D, Bridges J, Burke J M. et al Implementing the ACGME general competencies in a cardiothoracic surgery residency program using 360‐degree feedback. Ann Thorac Surg 2004. 7712–17.17 [PubMed]
7. Waldman D A, Bowen D E. The acceptability of 360‐degree feedback: a customer‐supplier relationship perspective. Human Resource Management 1998. 37117–129.129
8. Violato C, Lockyer J, Fidler H. Multisource feedback: a method of assessing surgical practice. BMJ 2003. 326546–548.548 [PMC free article] [PubMed]
9. Accreditation Council of Graduate Medical Education Outcome Project. http://www.acgme.org/Outcome/assess/assHome.asp

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