JAAPA Podcast Episode Summary

Episode Overview

Title: Peer Feedback: a tool to improve PA, NP, and physician collaboration and clinical practice
Date: May 3, 2024
Guests: Alexandra Gallant & Laura Erdman
Podcast: JAAPA Podcast (Journal of the American Academy of Physician Assistants)

This episode explores the development and impact of a peer feedback platform designed to enhance collaboration and clinical practice among Physician Assistants (PAs), Nurse Practitioners (NPs), and Physicians. Drawing on their experience at the University of Colorado Hospital, guests Alexandra Gallant and Laura Erdman discuss the research, methodology, outcomes, and broader implications of peer feedback in team-based care.

Guest Introductions & Fun Facts

[01:39-02:31]:

• Laura Erdman: Academic hospitalist, University of Colorado Hospital; leadership roles include APP schedule lead and co-chair of the Division of Oncology Clinical Case Review Series.
  • Fun fact: "After this reporting I'm going to get a tattoo." ([02:19])
• Alexandra Gallant ("Lexi"): Academic hospitalist; Director roles in Provider Experience/Wellness and APP Onboarding.
  • Fun fact: "I read 92 books last year." ([02:23])

Why Peer Feedback? The Origin Story

[03:02-04:39]:

• Laura describes dissatisfaction with annual reviews that failed to reflect clinical work and lacked meaningful feedback from peers.
  • “You don’t get feedback from other clinicians or nurses or team members.” ([03:18])
• She and Lexi recognized this gap and initiated the peer feedback project to better capture clinicians' everyday contributions.

Defining Peer Feedback & Implementation

[04:39-06:13]:

• Peer Feedback = Bidirectional, non-hierarchical feedback between PAs, NPs, and Physicians, focusing on mutual collaboration.
• At University of Colorado, teams work overlapping clinical stretches, providing a natural opportunity for end-of-week feedback.
• The team leveraged an existing platform (myEvals) used for learner evaluations, expanding it to include peer feedback.
  • “It was a platform that already everyone in the faculty group was integrated into… so it was kind of a natural expansion.” ([06:13])

Needs Assessment, Survey Structure, and Goals

[07:14-10:14]:

• Initial needs assessment sent to 101 faculty members
  • Findings: 75% felt they received no clinical skills feedback post-training; 97% were interested in a peer feedback program.
  • “A huge number of the group felt like they were lacking in that kind of feedback that they wanted.” ([07:40])
• Feedback platform was intentionally not anonymous to encourage timely, natural feedback.
• Goals:
  1. Highlight strengths and encourage clinical growth.
  2. Facilitate thoughtful, respectful peer feedback.
  3. Build a collaborative culture.
• Survey Questions:
  • “What are three things this person does well?”
  • “What is one thing this person could improve upon?”
• Prompts were offered (e.g., efficiency, teamwork) but responses were open-ended.

Challenges: The COVID-19 Context

[10:14-11:18]:

• Dual impact: reduced engagement due to stress/overwork, but increased willingness to “build people up.”
  • “There was so much appreciation for your colleagues and we all kind of had like, for lack of a better word, trauma bonding during Covid.” ([10:51])

Pilot & Rollout: How Did It Work?

[11:40-13:20]:

• One-month pilot with oncology teams to test technical aspects and gather informal feedback.
  • “People really liked giving kudos to their colleagues. They did say the not anonymous part made it a little bit awkward… but… would use it.” ([12:22])
• The same questions were used for all clinical roles, underlining peer equality.
• Platform then expanded to all medical, hospitalist, and consult teams.

Key Findings: Themes from Peer Feedback

[13:40-16:34]:

• Positive Themes:
  • Medical knowledge
  • Efficiency
  • Communication
  • Education/teaching
  • Bedside manner
  • Patient advocacy
• Role Differences:
  • PAs/NPs received praise for knowledge, efficiency, communication, bedside manner.
  • Physicians were repeatedly praised for APP advocacy—a theme not prompted by the survey.
    • “The MDs getting a lot of comments on APV advocacy wasn’t something that we had necessarily expected to see.” ([15:57])
• Constructive Feedback:
  • PAs/NPs: Improve bedside teaching, efficiency.
  • Physicians: Efficiency.
  • Non-anonymous nature and COVID period may have reduced critical feedback, but the intent was to foster a positive, growth-focused culture.

Memorable Quotes & Moments

• On feedback value:
  • “At the very least, it would be a nice boost in self confidence and likely would result in actionable items for self improvement.” – Laura Erdman & Alexandra Gallant ([28:49])
• On teamwork differences:
  • “Physicians really appreciate PAs and nurse practitioners who are really thorough but efficient, are really knowledgeable and are like experts at kind of like hospital complexity... Our NP/PAs really appreciated physicians who gave them autonomy… and were great team players.” – Alexandra Gallant ([16:58])
• On project’s broader applicability:
  • “Our hope and our belief is that it is impactful no matter where you’re getting it... Even if the structure isn’t the same... people can start to utilize those around them to incorporate feedback into their clinical growth.” – Laura Erdman ([21:01])
• On cultivating feedback culture:
  • “I think our hope too is that as people get used to having this structure, especially as people come into our group from outside institutions… some of this happens a little more naturally.” – Laura Erdman ([29:20])

Implications & Broader Impact

[19:07-21:01]:

• Peer feedback boosts team culture and provides actionable data for individual and systemic growth.
• Presenting aggregate feedback data at Grand Rounds allowed team members to see broader trends and normalize their experiences, promoting division-wide improvements.
• The platform is beneficial in both academic and community or private practice settings, though implementation may vary.

Integrating Optimal Team Practice & Future Directions

[22:18-27:32]:

• The AAPA Optimal Team Practice encourages team-based care and the removal of unnecessary administrative barriers.
• Peer feedback helps PAs practice at the top of their license and supports professional development/promotion.
  • “Our feedback platform… really pulled out a lot of those pieces that lead to making somebody clinically excellent.” – Alexandra Gallant ([23:31])
• Future research: Expansion to include nights/swing shifts, and exploration of other feedback moments (e.g., team handoff).

Practical Takeaways & Cultural Shifts

[27:32-29:57]:

• Feedback is vital for self-improvement and for fostering open communication; benefits everyone, regardless of outcome.
• Over time, giving and receiving feedback can become a natural, embedded part of the workplace culture.
• Peer feedback provides tangible evidence of clinical strengths for performance reviews and promotion pathways.
  • “Now you have like information that you’d never had on your clinical skills to be able to, to show people what you’re doing.” – Alexandra Gallant ([29:57])

Notable Quotes with Speaker & Timestamps

• Laura Erdman [03:18]:
  “You don’t get feedback from other clinicians or nurses or team members.”
• Alexandra Gallant [07:40]:
  “A huge number of the group felt like they were lacking in that kind of feedback that they wanted.”
• Laura Erdman [10:51]:
  “There was so much appreciation for your colleagues and we all kind of had like, for lack of a better word, trauma bonding during Covid.”
• Alexandra Gallant [15:57]:
  “The MDs getting a lot of comments on APV advocacy wasn’t something that we had necessarily expected to see.”
• Laura Erdman [28:49]:
  “At the very least, it would be a nice boost in self confidence and likely would result in actionable items for self improvement.”

Key Timestamps

| Timestamp | Segment | |-----------|----------------------------------------------------------| | 01:39 | Guest introductions and fun facts | | 03:02 | Origin of the peer feedback project | | 04:39 | Defining peer feedback and building the platform | | 07:14 | Needs assessment and survey design | | 10:14 | COVID-19 challenges and effects | | 11:40 | Pilot testing, feedback, and decision to rollout broadly | | 13:40 | Key feedback themes and analysis | | 16:58 | Highlights of team differences and impact | | 19:07 | Team culture and feedback impact | | 21:01 | Applicability in community settings | | 22:18 | AAPA’s Optimal Team Practice and clinical implications | | 27:32 | Feedback’s practical role in improvement and promotion |

Conclusion

This episode underscores the power of structured, bidirectional peer feedback to improve clinical practice, team culture, and professional development among PAs, NPs, and physicians. By making feedback a routine, positive, and useful experience, teams can foster greater collaboration, reduce hierarchy, and ensure that all members can grow to their full potential—“building yourselves, building your team and making it better for patients.” ([29:57] – Alexandra Gallant)