Factors Influencing Dictated Feedback on Resident Operative Performance: Insights From Simpl App.

Objective: We sought to determine if resident characteristics (postgraduate year (PGY) level, performance) and case factors (supervision type, task complexity) affect the likelihood of receiving dictated feedback (DFB) in SIMPL evaluation. We hypothesize that resident performance will be associated with the likelihood of receiving DFB, with intermediate performers receiving the most DFB over underperformers and expert performers.

Design: Retrospective cross-sectional study analyzing operative performance evaluations from the SIMPL app.

Setting: A single midwestern general surgery residency program at a tertiary care academic hospital.

Participants: Attending surgeon evaluations of general surgery residents (postgraduate year, PGY 1-5) between March 2022 and April 2024 (n = 901 cases).

Results: Overall, 566 of 901 evaluations (62.8%) included dictated feedback. Junior residents were significantly more likely to receive DFB than senior residents with 80.1% of PGY2 evaluations included feedback compared to 44.9% of PGY5 (p < 0.001). DFB frequency varied by attending supervision: it was most common during "Show and Tell" (77.8% of cases with feedback) and "Active Help" (70.3%) supervision, whereas only about half of the "Supervision Only" cases had feedback (47.2%, p < 0.001). Resident performance level was also associated with feedback (p < 0.001): trainees rated "Unprepared" (77.9% with feedback) or "Inexperienced/Intermediate" (68.6%) received feedback more often than those rated "Practice Ready" (52.4%) or "Exceptional" (56.7%). Female residents were less likely to receive feedback than male residents (59.1% vs 66.2%, p = 0.029). Attending academic rank correlated with feedback provision (p < 0.001): associate professors and full professors gave DFB in 67.1% and 77.7% of their evaluations, respectively, more often than instructors or assistant professors. There were no significant differences in DFB rates by attending surgeon gender (p = 0.582), case complexity (p = 0.115), or resident-attending gender concordance (p = 0.550).

Conclusion: In this single-institution study, the likelihood of receiving dictated operative feedback was influenced by resident seniority, intraoperative supervision level, and resident performance rating. These findings highlight the need for structured feedback practices to ensure all residents - including senior and high-performing trainees - receive timely, constructive operative feedback. Addressing potential disparities (such as by trainee gender or faculty experience) through faculty development and standardized evaluation processes may promote more equitable and educational feedback in surgical training.