title: Interns' perceptions of performance feedback.
abstract: BACKGROUND
  Internship, the first year after medical school, is an important time for identity formation and role development. Effective performance feedback is essential for identifying strengths and weaknesses, guiding self-regulation to improve clinical performance and developing accurate self-assessment. However, developing feedback systems is notoriously difficult. A better understanding of interns' perspectives is important to increase engagement with feedback systems and to improve their effectiveness.
  
  
  METHODS
  This study explores the interns' role clarity and confidence in evaluating their own performance; their views of the existing health care organisation's formal performance appraisal system based on national intern assessment tools and guidelines and whether the self-directed audit of clinical tasks is a feasible feedback tool. Qualitative data were collected through a cross-sectional survey using semi-structured interviews with interns in their last week of employment from a single large regional public health care organisation in Australia. Interviewee-verified data were analysed thematically using a 'framework' approach.
  
  
  RESULTS
  Twenty-one of 28 interns were included in the final analyses. We found that interns conceptualise good performance in terms of efficient completion of daily tasks and are unable to confidently judge their own performance. The current health care organisation performance appraisal system based on national intern assessment tools and guidelines does not meet their expectations and could be improved through greater involvement of the medical staff who work alongside interns on a daily basis, particularly registrars and regular, scheduled opportunities for formative and informal feedback with a focus on personalised, constructive feedback. The introduction of specific task assessments or audit, such as a formal appraisal of patient discharge documentation, is also valued.
  
  
  CONCLUSIONS
  Performance appraisal formats need improving to better align with interns' expectations, to meet interns' learning goals and to improve practices in the health care organisation.
authors.affiliation: Monash University, Prevention Research Unit, Department of Forensic Medicine, School of Public Health and Preventative Medicine, Melbourne, Victoria, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ibrahim
authors.forename: Aleece
authors.initials: A
authors.lastname: MacPhail
authors.forename: Liam
authors.initials: L
authors.lastname: Chadwick
authors.forename: Shelly
authors.initials: S
authors.lastname: Jeffcott
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods*; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008485:Medical Audit; D063886:Patient Discharge Summaries / Q000592:standards; D010819:Physician's Role / Q000523:psychology; D036301:Qualitative Research; D012647:Self-Assessment; D013337:Students, Medical / Q000523:psychology*