From Their Eyes: What Constitutes Quality Formative Written Feedback for Neurosurgery Residents

Chris J. Neal*, Steven J. Durning, Rajeev Dharmapurikar, Katherine E. McDaniel, Shivanand P. Lad, Michael M. Haglund

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: The characteristics of quality feedback from the neurosurgery resident's perspective are not fully elucidated. The Surgical Autonomy Program is an intraoperative assessment tool based on Vygotsky's Zone of Proximal Development (ZPD). SAP facilitates assessment of a resident's operative performance accompanied by written feedback. Objective: The goal of this study was twofold: to identify themes from the written feedback of SAP operative assessments and to examine if these themes influenced the neurosurgery residents’ perception of feedback quality. Methods: In 2021, SAP data from 2019-2021 at two neurosurgery programs were reviewed. Feedback quality from the SAP was determined by the resident at the time of their assessment. Using a constant comparative technique, the feedback was coded using a thematic analysis. The quality of feedback within each code was analyzed. Results: There were 2968 SAP entries evaluated. When the ZPD concept was fully used, residents reported high quality feedback 91.4% of the time compared to 58.6% when ZPD was not used (p < 0.001). Qualitative analysis of the written feedback revealed five themes: Non-Specific, Specific General Observations, Key Points, Next Steps, and Independent Practice. Feedback in the Specific General Observations, Key Points, and Independent Practice categories were associated with higher level feedback than leaving the space blank (p < 0.001) or writing Non-Specific comments (p < 0.001). Conclusions: Providing comments that discuss the resident's specific performance in the case, key learning points, or their progress towards independence, results in high quality feedback. Utilizing a theory-based tool such as the SAP can provide meaningful feedback to neurosurgical residents.

Original languageEnglish
Pages (from-to)323-330
Number of pages8
JournalJournal of Surgical Education
Issue number3
StatePublished - Mar 2023
Externally publishedYes


  • Education
  • Feedback
  • Neurosurgery
  • Surgical Autonomy Program
  • Zone of Proximal Development


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