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Park KY, Kang YJ, Park HK, Hwang HS. Exploring effective video-review strategies of patient encounters for medical students: precepted review versus peer discussion. MEDICAL EDUCATION ONLINE 2024; 29:2392428. [PMID: 39154381 PMCID: PMC11332281 DOI: 10.1080/10872981.2024.2392428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Video-recordings review of patient encounters is reported to improve the clinical performance of medical students. However, evidence on specific remediation strategies or outcomes are lacking. We aimed to implement videorecording-based remediation of standardized patient encounters among medical students, combined with preceptor one-on-one feedback or peer group discussion, and evaluate the effectiveness of the two remediation methods using objective structured clinical examination (OSCE). METHODS Following standardized patient encounters, 107 final-year medical students were divided into two groups based on different remediation methods of video review: (1) precepted video review with preceptor feedback (N = 55) and (2) private video review and subsequent peer group discussion under supervision (N = 52). All students underwent twelve-stations of OSCE both before and after the video review. Students' pre- and post-remediation OSCE scores, self-efficacy level in patient encounters, and level of educational satisfaction with each method were assessed and compared between different video-based remediation methods to evaluate their respective effects. RESULTS After remediation, the total and subcomponent OSCE scores, such as history taking, physical examination, and patient - physician interaction (PPI), among all students increased significantly. Post-remediation OSCE scores showed no significant difference between two remediation methods (preceptor module, 79.6 ± 4.3 vs. peer module, 79.4 ± 3.8 in the total OSCE score). Students' self-efficacy levels increased after remediation in both modules (both p-value <0.001), with no difference between the two modules. However, students' satisfaction level was higher in the preceptor module than in the peer module (80.1 ± 17.7 vs. 59.2 ± 25.1, p-value <0.001). Among students with poor baseline OSCE performance, a prominent increase in PPI scores was observed in the preceptor-based module. CONCLUSION Video-based remediation of patient encounters, either through preceptor review with one-on-one feedback or through private review with peer discussion, was equally effective in improving the OSCE scores and self-efficacy levels of medical students. Underperforming students can benefit from precepted video reviews for building PPI.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ye Ji Kang
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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Cardella L, Lang V, Cross W, Mooney C. Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:329-333. [PMID: 38740718 DOI: 10.1007/s40596-024-01973-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. METHODS In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. RESULTS Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). CONCLUSIONS The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.
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Affiliation(s)
- Laura Cardella
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Valerie Lang
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Wendi Cross
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Christopher Mooney
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Bearman M, Dracup M, Ajjawi R, Kirby C, Brown J. Feedback, learning and becoming: Narratives of feedback in complex performance challenges. MEDICAL EDUCATION 2024. [PMID: 38978135 DOI: 10.1111/medu.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Becoming a general practitioner (or family medicine specialist) is challenging, as trainees learn to manage complex and ambiguous situations. Feedback is a key component of this learning. Although research has tended to focus on feedback's momentary processes and impacts, there is value in seeking to understand the work it does over time and how trainees position themselves across multiple feedback encounters. We ask: how do newly qualified GPs narrate themselves and their experiences with complex performance challenges? Within these narratives, what is the role of feedback? METHODS The research adopts a holistic and sequential narrative analysis approach, with in-depth narrative interviews of 16 general practice trainees who had just completed their training requirements. The analysis involved restorying the participant narratives chronologically. Each narrative formed a unit of analysis where narrative commonalities across plots, characters, emotions and the role of feedback were interpreted. RESULTS Four plotlines within GP trainees' stories of complex performance challenges were identified: Journeyperson, Hero's Quest, Solo Journeyer and Endless Struggle. Trainees, supervisors and feedback are positioned differently within these plotlines. Narratives were saturated with emotions. DISCUSSION The plotlines bring together an alternative way of understanding how feedback, learning and becoming are woven together. They illustrate how multiple interactions with patients, supervisors, peers and systems thread together into an overall trajectory. How a trainee positions themselves as protagonists and who they characterise as their antagonists can help direct the focus of supervisors' feedback conversations.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | - Mary Dracup
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Burwood, Victoria, Australia
| | | | - James Brown
- Sexual Health Victoria, Melbourne, Victoria, Australia
- Royal Australasian College of General Practitioners (RACGP), Melbourne, Victoria, Australia
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Hoang K, Grow HM, Rooholamini SN, McPhillips H, Selling SK, Rassbach CE, Blankenburg R. Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Acad Pediatr 2024; 24:866-874. [PMID: 38729301 DOI: 10.1016/j.acap.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. METHODS In July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. RESULTS We interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates' PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. CONCLUSIONS Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.
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Affiliation(s)
- Kim Hoang
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif.
| | - Helene Mollie Grow
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sahar N Rooholamini
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Heather McPhillips
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sarah Kate Selling
- Department of Pediatrics, Stanford University School of Medicine (SK Selling), Calif
| | - Caroline E Rassbach
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
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Simon TA, Owais S, Duarte D, Acai A. Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program. J Grad Med Educ 2024; 16:312-317. [PMID: 38882435 PMCID: PMC11173005 DOI: 10.4300/jgme-d-23-00643.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/30/2023] [Accepted: 03/12/2024] [Indexed: 06/18/2024] Open
Abstract
Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.
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Affiliation(s)
- Taryn A Simon
- is a Research Assistant, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sawayra Owais
- is a MD/PhD Candidate, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- is Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Geriatric Psychiatrist, Seniors Mental Health Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; and
| | - Anita Acai
- is Assistant Professor and Education Scientist, Department of Psychiatry and Behavioural Neurosciences and McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, and Education Scientist, St. Joseph's Education & Research Centre (SERC), St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Torre D, Daniel M, Ratcliffe T, Durning SJ, Holmboe E, Schuwirth L. Programmatic Assessment of Clinical Reasoning: New Opportunities to Meet an Ongoing Challenge. TEACHING AND LEARNING IN MEDICINE 2024:1-9. [PMID: 38794865 DOI: 10.1080/10401334.2024.2333921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/29/2024] [Indexed: 05/26/2024]
Abstract
Issue: Clinical reasoning is essential to physicians' competence, yet assessment of clinical reasoning remains a significant challenge. Clinical reasoning is a complex, evolving, non-linear, context-driven, and content-specific construct which arguably cannot be assessed at one point in time or with a single method. This has posed challenges for educators for many decades, despite significant development of individual assessment methods. Evidence: Programmatic assessment is a systematic assessment approach that is gaining momentum across health professions education. Programmatic assessment, and in particular assessment for learning, is well-suited to address the challenges with clinical reasoning assessment. Several key principles of programmatic assessment are particularly well-aligned with developing a system to assess clinical reasoning: longitudinality, triangulation, use of a mix of assessment methods, proportionality, implementation of intermediate evaluations/reviews with faculty coaches, use of assessment for feedback, and increase in learners' agency. Repeated exposure and measurement are critical to develop a clinical reasoning assessment narrative, thus the assessment approach should optimally be longitudinal, providing multiple opportunities for growth and development. Triangulation provides a lens to assess the multidimensionality and contextuality of clinical reasoning and that of its different, yet related components, using a mix of different assessment methods. Proportionality ensures the richness of information on which to draw conclusions is commensurate with the stakes of the decision. Coaching facilitates the development of a feedback culture and allows to assess growth over time, while enhancing learners' agency. Implications: A programmatic assessment model of clinical reasoning that is developmentally oriented, optimizes learning though feedback and coaching, uses multiple assessment methods, and provides opportunity for meaningful triangulation of data can help address some of the challenges of clinical reasoning assessment.
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Affiliation(s)
- Dario Torre
- Department of Medical Education, University of Central Florida, Orlando, FL, USA
| | - Michelle Daniel
- Department of Emergency Medicine, University of California, San Diego, CA, USA
| | - Temple Ratcliffe
- Department of Medicine, The Joe R and Teresa Lozano Long School of Medicine at University of Texas Health, Texas, USA
| | - Steven J Durning
- Center for Heath Profession Education, Uniformed Services University Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Eric Holmboe
- Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA
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Ginsburg S, Stroud L, Brydges R, Melvin L, Hatala R. Dual purposes by design: exploring alignment between residents' and academic advisors' documents in a longitudinal program. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10318-2. [PMID: 38438699 DOI: 10.1007/s10459-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
Longitudinal academic advising (AA) and coaching programs are increasingly implemented in competency based medical education (CBME) to help residents reflect and act on the voluminous assessment data they receive. Documents created by residents for purposes of reflection are often used for a second, summative purpose-to help competence committees make decisions-which may be problematic. Using inductive, thematic analysis we analyzed written comments generated by 21 resident-AA dyads in one large internal medicine program who met over a 2 year period to determine what residents write when asked to reflect, how this aligns with what the AAs report, and what changes occur over time (total 109 resident self-reflections and 105 AA reports). Residents commented more on their developing autonomy, progress and improvement than AAs, who commented far more on performance measures. Over time, residents' writing shifted away from intrinsic roles, patient care and improvement towards what AAs focused on, including getting EPAs (entrustable professional activities), studying and exams. For EPAs, the emphasis was on getting sufficient numbers rather than reflecting on what residents were learning. Our findings challenge the practice of dual-purposing documents, by questioning the blurring of formative and summative intent, the structure of forms and their multiple conflicting purposes, and assumptions about the advising relationship over time. Our study suggests a need to re-evaluate how reflective documents are used in CBME programs. Further research should explore whether and how documentation can best be used to support resident growth and development.
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Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada.
| | - Lynfa Stroud
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Melvin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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Richardson D, Landreville JM, Trier J, Cheung WJ, Bhanji F, Hall AK, Frank JR, Oswald A. Coaching in Competence by Design: A New Model of Coaching in the Moment and Coaching Over Time to Support Large Scale Implementation. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:33-43. [PMID: 38343553 PMCID: PMC10854464 DOI: 10.5334/pme.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024]
Abstract
Coaching is an increasingly popular means to provide individualized, learner-centered, developmental guidance to trainees in competency based medical education (CBME) curricula. Aligned with CBME's core components, coaching can assist in leveraging the full potential of this educational approach. With its focus on growth and improvement, coaching helps trainees develop clinical acumen and self-regulated learning skills. Developing a shared mental model for coaching in the medical education context is crucial to facilitate integration and subsequent evaluation of success. This paper describes the Royal College of Physicians and Surgeons of Canada's coaching model, one that is theory based, evidence informed, principle driven and iteratively and developed by a multidisciplinary team. The coaching model was specifically designed, fit for purpose to the postgraduate medical education (PGME) context and implemented as part of Competence by Design (CBD), a new competency based PGME program. This coaching model differentiates two coaching roles, which reflect different contexts in which postgraduate trainees learn and develop skills. Both roles are supported by the RX-OCR process: developing Relationship/Rapport, setting eXpectations, Observing, a Coaching conversation, and Recording/Reflecting. The CBD Coaching Model and its associated RX-OCR faculty development tool support the implementation of coaching in CBME. Coaching in the moment and coaching over time offer important mechanisms by which CBD brings value to trainees. For sustained change to occur and for learners and coaches to experience the model's intended benefits, ongoing professional development efforts are needed. Early post implementation reflections and lessons learned are provided.
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Affiliation(s)
- Denyse Richardson
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason R. Frank
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, ON, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
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Miles K, O'Neill B, Li S. The 'Kidney' model for optimising feedback in undergraduate clinical communication: A meta-ethnographic systematic review. PATIENT EDUCATION AND COUNSELING 2024; 119:108050. [PMID: 37948906 DOI: 10.1016/j.pec.2023.108050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Feedback frameworks/models focus on certain aspects of the feedback process, but a coherent and systematic model is lacking. A meta-ethnography was conducted to identify and synthesise guidance for optimising feedback interactions in undergraduate clinical communication simulations. METHODS A systematic search of 4 electronic databases and grey literature was conducted. Following Noblit and Hare's seven phases for conducting meta-ethnography, key themes and concepts were synthesised to provide new interpretations of components in effective feedback interactions. RESULTS 373 publications were identified and 14 included for the final synthesis, which informed the development of a new Feedback Kidney Model. The Model illustrates the interconnections of various components that allow for effective feedback interactions. The main processes include preparation, proactivity, analysis and feedback information, reception and response, and influencing factors. CONCLUSIONS This meta-ethnography moves beyond providing an up-to-date synthesis of feedback guidance to proposing the brand-new Feedback Kidney Model, which can guide medical education and future research into how feedback is co-constructed and utilised to promote learning. PRACTICE IMPLICATIONS Clinical communication should incorporate meta-cognitive training and using this Model will help students better utilise on-site face-to-face feedback to enhance their learning and improve future communication with patients.
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Affiliation(s)
- Katherine Miles
- Department of Pharmacology, Public Health and Clinical Skills, Faculty of Medicine, Hashemite University, Zarqa, Jordan; GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Bernadette O'Neill
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shuangyu Li
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK; King's Cultural Competency Unit, Faculty of Arts and Humanities, King's College London, UK.
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Waisanen K, Parmar G, Iskhakov N, Baetzhold D, Lutnick E, Henning F, Saade K, Peterson M, Nader N, Chevli KK. Evaluation of Educational Feedback in Urology Training: A Survey-Based Assessment of Trainees and Program Directors. Cureus 2024; 16:e51716. [PMID: 38318556 PMCID: PMC10838810 DOI: 10.7759/cureus.51716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Our objective was to evaluate current satisfaction with the feedback provided during post-graduate urological training, including the quality and frequency of feedback, with participants consisting of both trainees and program directors. Additionally, we aimed to identify areas for future improvement in resident and fellow-level urological training. METHODS Graduating residents, fellows, and program directors from accredited residency/fellowship programs in the United States were surveyed. A total of 575 surveys were sent out. Information on feedback frequency, quality, form, and satisfaction was collected using applicable multiple-choice responses and a five-point Likert scale. An open-ended question gathered suggestions for improving current feedback processes. A chi-square test of independence was used to compare the responses to individual questions. RESULTS Ninety-two respondents answered our survey: 22 residents, 18 fellows, 25 residency program directors (PDs), and 27 fellowship PDs. The distribution of age, race, and gender categories was not significantly different between PDs and trainees. However, there was a significant difference in their subspecialties and American Urological Association (AUA) sections. The majority of fellowship PDs, residency PDs, fellows, and residents (88 total) reported verbal feedback as the predominant method within their practice. This was followed by written (68 total), electronic (54 total), and app-based feedback (19 total). CONCLUSION Our study suggests that there may be a need for ongoing improvement or standardization of feedback mechanisms in the field of urological training and highlights the perceived discrepancies between learners and educators.
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Affiliation(s)
- Kyle Waisanen
- Urology, Lee Physician Group Urology, Fort Myers, USA
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Gaganjot Parmar
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Nathaniel Iskhakov
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Daniel Baetzhold
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Ellen Lutnick
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Finn Henning
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Kiana Saade
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Matthew Peterson
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Nader Nader
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
- VA (Veteran Affairs) WNY (Western New York) Health Care System, Buffalo VA Medical Center, Buffalo, USA
| | - K Kent Chevli
- Urology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
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Robb KA, Rosenbaum ME, Peters L, Lenoch S, Lancianese D, Miller JL. Feedback conversations: First things first? PATIENT EDUCATION AND COUNSELING 2023; 115:107849. [PMID: 37393684 DOI: 10.1016/j.pec.2023.107849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This study explores medical students' perceptions regarding the order in which feedback is given and its impact on how that feedback is received. METHODS Medical students were interviewed regarding their feedback experiences during medical school and preferred order in which to receive feedback. Thematic analysis was applied to interview transcripts to identify salient themes in students' comments related to feedback order. RESULTS Twenty-five students entering their second, third, and fourth years of medical school participated in the study. Students indicated that the order in which feedback was conveyed influenced their receptivity to its content, but varied in their specific order preferences. Most students indicated that they preferred feedback conversations that started with positive observations. Only the most senior students expressed a preference for feedback based on self-assessment. CONCLUSION Feedback conversations are complicated interactions. Students' responses to feedback are influenced by a variety of factors, including the order in which feedback is delivered. PRACTICE IMPLICATIONS Educators should recognize that students' feedback needs may be influenced by a variety of factors, and should aim to tailor feedback and the order of its delivery to the learner.
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Affiliation(s)
- Katharine A Robb
- Department of Pediatrics, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
| | - Marcy E Rosenbaum
- Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Lauren Peters
- Department of Communication Studies, University of Iowa, Iowa City, IA, USA
| | - Susan Lenoch
- Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Donna Lancianese
- Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Jane L Miller
- Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Birkeli CN, Normand C, Rø KI, Kvernenes M. Educational supervision in internal medicine residency training - a scoping review. BMC MEDICAL EDUCATION 2023; 23:644. [PMID: 37679738 PMCID: PMC10486128 DOI: 10.1186/s12909-023-04629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Although supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee's progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents' learning. METHODS We conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.'s modification of Arksey and O'Malley's six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research. RESULTS Eighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents' learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation. CONCLUSION The distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.
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Affiliation(s)
- Cecilie Normann Birkeli
- Institute for Studies of the Medical Profession, P.O. Box 1153, Oslo, NO-0107, Norway.
- Center for Medical Education, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Camilla Normand
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karin Isaksson Rø
- Institute for Studies of the Medical Profession, P.O. Box 1153, Oslo, NO-0107, Norway
| | - Monika Kvernenes
- Center for Medical Education, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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13
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Lockyer J, Lee-Krueger R, Armson H, Hanmore T, Koltz E, Könings K, Mahalik A, Ramani S, Roze des Ordons A, Trier J, Zetkulic M, Sargeant J. Application of the R2C2 Model to In-the-Moment Feedback and Coaching. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1062-1068. [PMID: 37797303 DOI: 10.1097/acm.0000000000005237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use. METHOD A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor-learner dyads. Data were collected during feedback sessions and follow-up interviews between March 2021 and July 2022. The research team familiarized themselves with the data, used a coding template to document examples of the model's application, reviewed the initial framework and revised the coding template, indexed and summarized the data, created a summary document, examined the transcripts for alignment with each model phase, and identified illustrative quotations and overarching themes. RESULTS Fifteen dyads were recruited from 8 disciplines (11 preceptors were paired with a single resident [n = 9] or a single medical student [n = 2]; 2 preceptors each had 2 residents). All dyads were able to apply the R2C2 phases of building relationships, exploring reactions and reflections, and confirming content. Many struggled with the coaching components, specifically in creating an action plan and follow-up arrangements. Preceptor skill in applying the model, time available for feedback conversations, and the nature of the relationship impacted how the model was applied. CONCLUSIONS The R2C2 model can be adapted to contexts where in-the-moment feedback conversations occur shortly after a clinical encounter. Experiential learning approaches applying the R2C2 model are critical. Skillful application of the model requires that learners and preceptors go beyond confirming an area of change and deliberately engage in coaching and cocreating an action plan.
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Affiliation(s)
- Jocelyn Lockyer
- J. Lockyer is professor emerita and adjunct professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-3928-4827
| | - Rachelle Lee-Krueger
- R. Lee-Krueger is an education consultant, Office of Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-6122-1868
| | - Heather Armson
- H. Armson is professor and assistant dean, Department of Family Medicine, Office of Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-7147-6749
| | - Tessa Hanmore
- T. Hanmore is an educational consultant, Departments of Ophthalmology, Psychiatry, and Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-4654-9969
| | - Elizabeth Koltz
- E. Koltz is director of instructional and curricular design and assistant professor, Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey; ORCID: https://orcid.org/0000-0002-0368-7413
| | - Karen Könings
- K. Könings is associate professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-0063-8218
| | - Anne Mahalik
- A. Mahalik is an evaluation specialist, Continuing Professional Development & Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: https://orcid.org/0000-0003-3201-0871
| | - Subha Ramani
- S. Ramani is associate professor of medicine, Harvard Medical School, and adjunct professor, MGH Institute for Health Professions Education, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-8360-4031
| | - Amanda Roze des Ordons
- A. Roze des Ordons is clinical associate professor, Departments of Critical Care Medicine, Anesthesiology, and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-6480-4946
| | - Jessica Trier
- J. Trier is assistant professor, Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org//0000-0001-7478-8863
| | - Marygrace Zetkulic
- M. Zetkulic is associate professor of medicine and vice chair for medical education, Hackensack Meridian School of Medicine, Nutley, New Jersey; ORCID: https://orcid.org//0000-0002-2778-2124
| | - Joan Sargeant
- J. Sargeant is professor (postretirement), Continuing Professional Development and Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: https://orcid.org/0000-0003-0451-3674
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Berger S, Stalmeijer RE, Marty AP, Berendonk C. Exploring the Impact of Entrustable Professional Activities on Feedback Culture: A Qualitative Study of Anesthesiology Residents and Attendings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:836-843. [PMID: 36812061 DOI: 10.1097/acm.0000000000005188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) were introduced as a potential way to optimize workplace-based assessments. Yet, recent studies suggest that EPAs have not yet overcome all of the challenges to implementing meaningful feedback. The aim of this study was to explore the extent to which the introduction of EPAs via mobile app impacts feedback culture as experienced by anesthesiology residents and attending physicians. METHOD Using a constructivist grounded theory approach, the authors interviewed a purposive and theoretical sample of residents (n = 11) and attendings (n = 11) at the Institute of Anaesthesiology, University Hospital of Zurich, where EPAs had recently been implemented. Interviews took place between February and December 2021. Data collection and analysis were conducted iteratively. The authors used open, axial, and selective coding to gain knowledge and understanding on the interplay of EPAs and feedback culture. RESULTS Participants reflected on a number of changes in their day-to-day experience of feedback culture with the implementation of EPAs. Three main mechanisms were instrumental in this process: lowering the feedback threshold, change in feedback focus, and gamification. Participants felt a lower threshold to feedback seeking and giving and that the frequency of feedback conversations increased and tended to be more focused on a specific topic and shorter, while feedback content tended to focus more on technical skills and more attention was given to average performances. Residents indicated that the app-based approach fostered a game-like motivation to "climb levels," while attendings did not perceive a game-like experience. CONCLUSIONS EPAs may offer a solution to problems of infrequent occurrence of feedback and invite attention to average performances and technical competencies, but may come at the expense of feedback on nontechnical skills. This study suggests that feedback culture and feedback instruments have a mutually interacting influence on each other.
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Affiliation(s)
- Sabine Berger
- S. Berger is a third-year medical resident, Internal Medicine Training Program, St. Claraspital, Basel, Switzerland
| | - Renee E Stalmeijer
- R.E. Stalmeijer is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Adrian P Marty
- A.P. Marty is currently senior attending physician and team lead for education, Institute of Anaesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital Balgrist, Zurich, Switzerland. At the time of writing, he was attending physician, Institute of Anaesthesiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Christoph Berendonk
- C. Berendonk is senior lecturer in medical education, Institute for Medical Education, University of Bern, Bern, Switzerland
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15
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Lip A, Watling CJ, Ginsburg S. What does "Timely" Mean to Residents? Challenging Feedback Assumptions in Postgraduate Education. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:218-227. [PMID: 37334109 PMCID: PMC10275343 DOI: 10.5334/pme.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
Introduction Current orthodoxy states that feedback should be timely and face-to-face, yet the optimal timing and mode of delivery for feedback is unclear. We explored what "optimal timing" means from residents' points of view as feedback providers and receivers, to ultimately inform strategies to optimize feedback in training. Methods As near-peers who have dual roles in both providing and receiving feedback, 16 subspecialty (PGY4 and 5) internal medicine residents were interviewed about their perceptions of the optimal timing and format of feedback. Using constructivist grounded theory, interviews were conducted and analyzed iteratively. Results Drawing on their experiences as providers and recipients, residents described simultaneously considering and weighing multiple factors when deciding on when and how to provide feedback. These included their own readiness to engage in providing meaningful feedback, the perceived receptiveness of the learner and the apparent urgency of feedback delivery (e.g., if patient safety was at stake). Face-to-face verbal feedback was valued for encouraging dialogue but could be uncomfortable and limited by time constraints. Written feedback could be more honest and concise, and the possibility of asynchronous delivery had potential to overcome issues with timing and discomfort. Discussion Participants' perceptions of the optimal timing of feedback challenge current assumptions about the benefits of "immediate" versus "delayed". The concept of "optimal timing" for feedback was found to be complex and context-dependent, defying a formulaic approach. There may be a role for asynchronous and/or written feedback, which has potential to address unique issues identified issues in near-peer relationships.
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Affiliation(s)
- Alyssa Lip
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, CA
| | - Christopher J. Watling
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA
| | - Shiphra Ginsburg
- Department of Medicine, Sinai Health System and Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CA
- Canada Research Chair in Health Professions Education, CA
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16
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Ajjawi R, Bearman M, Molloy E, Noble C. The role of feedback in supporting trainees who underperform in clinical environments. Front Med (Lausanne) 2023; 10:1121602. [PMID: 37181376 PMCID: PMC10167016 DOI: 10.3389/fmed.2023.1121602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Underperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance - both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance. Methods This narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment. Synthesis and discussion There are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of 'earned' failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or 'telling'. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Elizabeth Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, QLD, Australia
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17
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Westein MPD, Koster AS, Daelmans HEM, Bouvy ML, Kusurkar RA. How progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships: a mixed method study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:205-222. [PMID: 36094680 PMCID: PMC9992254 DOI: 10.1007/s10459-022-10153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
The combination of measuring performance and giving feedback creates tension between formative and summative purposes of progress evaluations and can be challenging for supervisors. There are conflicting perspectives and evidence on the effects supervisor-trainee relationships have on assessing performance. The aim of this study was to learn how progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships. Progress evaluations in a two-year community-pharmacy specialization program were studied with a mixed-method approach. An adapted version of the Canadian Medical Education Directives for Specialists (CanMEDS) framework was used. Validity of the performance evaluation scores of 342 trainees was analyzed using repeated measures ANOVA. Semi-structured interviews were held with fifteen supervisors to investigate their response processes, the utility of the progress evaluations, and the influence of supervisor-trainee relationships. Time and CanMEDS roles affected the three-monthly progress evaluation scores. Interviews revealed that supervisors varied in their response processes. They were more committed to stimulating development than to scoring actual performance. Progress evaluations were utilized to discuss and give feedback on trainee development and to add structure to the learning process. A positive supervisor-trainee relationship was seen as the foundation for feedback and supervisors preferred the roles of educator, mentor, and coach over the role of assessor. We found that progress evaluations are a good method for directing feedback in longitudinal supervisor-trainee relationships. The reliability of scoring performance was low. We recommend progress evaluations to be independent of formal assessments in order to minimize roles-conflicts of supervisors.
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Affiliation(s)
- Marnix P D Westein
- Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, The Netherlands.
- Research in Education, Faculty of Medicine Vrije Universiteit, Amsterdam, The Netherlands.
- The Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | - A S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, The Netherlands
| | - H E M Daelmans
- Programme Director Master of Medicine, Faculty of Medicine Vrije Universiteit, Amsterdam, The Netherlands
| | - M L Bouvy
- Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, The Netherlands
| | - R A Kusurkar
- Research in Education, Faculty of Medicine Vrije Universiteit, Amsterdam, The Netherlands
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Prescott-Clements L, Soreskog-Turp J, Crawford B, Williams K. The Development and Implementation of a National Veterinary Graduate Development Programme (VetGDP) to Support Veterinarians Entering the UK Workforce. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022:e20220112. [PMID: 36538366 DOI: 10.3138/jvme-2022-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The UK veterinary profession is facing significant challenges, including high rates of veterinarians leaving the profession amidst workforce shortages, alongside high levels of dissatisfaction, stress, and poor mental health. The highest rates of attrition are associated with veterinarians who have recently graduated and are at an early stage in their careers. Although there may be many contributory factors, a lack of adequate support during the transition from vet school into their first professional role following graduation may be one important cause. Consequently, it has never been more important to develop an effective system for supporting new graduates, which is accessible to all. A new Veterinary Graduate Development Programme (VetGDP) has been developed, using a framework of professional activities that are sufficiently flexible to create a bespoke, individualized program for each graduate depending on the role they enter. Each new graduate is assigned a dedicated coach (Adviser) within their workplace, who has been trained to provide effective support and has committed to doing so throughout the program. VetGDP has been implemented on a national scale in the UK; engagement is assured through the RCVS Code of Professional Conduct and quality assurance is in place. VetGDP has been developed using established educational, sociocultural, and behavioral theories, and the latest research in coaching and feedback within medical education. These methods, which aim to ensure there is the best possible impact on graduates' professional development, and the creation of a positive learning culture within the workplace, are taught to all Advisers via an e-learning package.
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Affiliation(s)
- Linda Prescott-Clements
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Jenny Soreskog-Turp
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Britta Crawford
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Kirsty Williams
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
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Trier J, Turnnidge J, McGuire CS, Côté J, Dagnone JD. It's a 'two-way street': resident perspectives of effective coaching relationships in the clinical learning environment. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:5-12. [PMID: 35875451 PMCID: PMC9297249 DOI: 10.36834/cmej.72940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coaching has gained traction in postgraduate medical education to enhance interactions between residents and clinical teachers, but these relationships present unique challenges and tensions. In order to realize the promises of coaching in medical education, we must understand how coaching relationships can be enacted to optimize resident development. The purpose of this study was to explore residents' perceptions of key characteristics for effective clinical teacher-resident (CT-R) coaching relationships. METHODS We conducted four focus groups and eight interviews with residents at a Canadian academic center. Using a social constructionist approach, focus groups and interviews were audio recorded, transcribed verbatim, and thematically analyzed. RESULTS Residents described three main characteristics that contributed to effective CT-R coaching relationships: safe, meaningful, and collaborative. Residents emphasized that these characteristics needed to be bidirectional in nature to be most effective, in that both the resident and clinical teacher embodied these characteristics. CONCLUSIONS Residents identified that effective coaching relationships were shaped not only by clinical teacher behaviours, but importantly, the quality of the interpersonal relationship that was fostered. Thus, it is imperative to consider the bidirectional nature of the CT-R coaching relationship when striving to enhance resident development.
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Affiliation(s)
- Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen’s University, Ontario, Canada
- Providence Care Hospital, Ontario, Canada
| | - Jennifer Turnnidge
- Office of Professional Development and Educational Scholarship, Queen’s University, Ontario, Canada
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - Jean Côté
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - J Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
- Kingston Health Sciences Centre, Ontario, Canada
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Button B, Cook C, Goertzen J, Cameron E. A Novel, Combined Student and Preceptor Professional Development Session for Optimizing Feedback: Protocol for a Multimethod, Multisite, and Multiyear Intervention. JMIR Res Protoc 2022; 11:e32829. [PMID: 35583554 PMCID: PMC9237756 DOI: 10.2196/32829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Providing feedback to medical learners is a critical educational activity. Despite the recognition of its importance, most research has focused on training preceptors to give feedback, which neglects the role of learners in receiving feedback. Delivering a combined professional development session for both preceptors and students may facilitate more effective feedback communication and improve both the quality and quantity of feedback. Objective The objective of our research project is to examine the impact of a relational feedback intervention on both preceptors and students during a longitudinal integrated clerkship. Methods Students and preceptors will attend a 2.5-hour combined professional development session, wherein they will be provided with educational tools for giving and receiving feedback within a coaching relationship and practice feedback giving and receiving skills together. Before the combined professional development session, students will be asked to participate in a 1-hour preparation session that will provide an orientation on their role in receiving feedback and their participation in the combined professional development session. Students and preceptors will be asked to complete a precombined professional development session survey and an immediate postcombined professional development session survey. Preceptors will be asked to complete a follow-up assessment survey, and students will be asked to participate in a follow-up, student-only focus group. Anonymized clinical faculty teaching evaluations and longitudinal integrated clerkship program evaluations will also be used to assess the impact of the intervention. Results As of March 1, 2022, a total of 66 preceptors and 29 students have completed the baseline and follow-up measures. Data collection is expected to conclude in December 2023. Conclusions Our study is designed to contribute to the literature on the feedback process between preceptors and students within a clinical setting. Including both the preceptors and the students in the same session will improve on the work that has already been conducted in this area, as the students and preceptors can further develop their relationships and coconstruct feedback conversations. We will use social learning theory to interpret the results of our study, which will help us explain the results and potentially make the work generalizable to other fields. International Registered Report Identifier (IRRID) DERR1-10.2196/32829
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Affiliation(s)
- Brenton Button
- Human Sciences Division, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Medical Education Research Lab in the North, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Faculty of Education, University of Winnipeg, Winnipeg, MB, Canada
| | - Clare Cook
- Medical Education Research Lab in the North, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Continuing Education and Professional Development, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - James Goertzen
- Medical Education Research Lab in the North, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Continuing Education and Professional Development, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Erin Cameron
- Human Sciences Division, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Medical Education Research Lab in the North, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.,Centre for Social Accountability, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
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21
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Westein MPD, Koster AS, Daelmans HEM, Collares CF, Bouvy ML, Kusurkar RA. Validity evidence for summative performance evaluations in postgraduate community pharmacy education. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:701-711. [PMID: 35809899 DOI: 10.1016/j.cptl.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Workplace-based assessment of competencies is complex. In this study, the validity of summative performance evaluations (SPEs) made by supervisors in a two-year longitudinal supervisor-trainee relationship was investigated in a postgraduate community pharmacy specialization program in the Netherlands. The construct of competence was based on an adapted version of the 2005 Canadian Medical Education Directive for Specialists (CanMEDS) framework. METHODS The study had a case study design. Both quantitative and qualitative data were collected. The year 1 and year 2 SPE scores of 342 trainees were analyzed using confirmatory factor analysis and generalizability theory. Semi-structured interviews were held with 15 supervisors and the program director to analyze the inferences they made and the impact of SPE scores on the decision-making process. RESULTS A good model fit was found for the adapted CanMEDS based seven-factor construct. The reliability/precision of the SPE measurements could not be completely isolated, as every trainee was trained in one pharmacy and evaluated by one supervisor. Qualitative analysis revealed that supervisors varied in their standards for scoring competencies. Some supervisors were reluctant to fail trainees. The competency scores had little impact on the high-stakes decision made by the program director. CONCLUSIONS The adapted CanMEDS competency framework provided a valid structure to measure competence. The reliability/precision of SPE measurements could not be established and the SPE measurements provided limited input for the decision-making process. Indications of a shadow assessment system in the pharmacies need further investigation.
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Affiliation(s)
- Marnix P D Westein
- Department of Pharmaceutical Sciences, Utrecht University, Royal Dutch Pharmacists Association (KNMP), Research in Education, Faculty of Medicine Vrije Universiteit, Amsterdam, the Netherlands.
| | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Hester E M Daelmans
- Master's programme of Medicine, Faculty of Medicine Vrije Universiteit, Amsterdam, the Netherlands.
| | - Carlos F Collares
- Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Marcel L Bouvy
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Rashmi A Kusurkar
- Research in Education, Faculty of Medicine Vrije Universiteit, Amsterdam, the Netherlands.
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Rassos J, Ginsburg S, Stalmeijer RE, Melvin LJ. The Senior Medical Resident's New Role in Assessment in Internal Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:711-717. [PMID: 34879012 DOI: 10.1097/acm.0000000000004552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE With the introduction of competency-based medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents' perceptions of near-peer feedback and assessment in the context of EPAs. METHOD Semistructured interviews were conducted from September 2019 to March 2020 with 16 internal medicine residents (8 first-year residents and 8 second- and third-year residents) at the University of Toronto, Toronto, Ontario, Canada. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until sufficiency was reached. RESULTS Senior residents noted a tension in their dual roles of coach and assessor when completing EPAs. Senior residents managed the relationship with junior residents to not upset the learner and potentially harm the team dynamic, leading to the documentation of often inflated EPA ratings. Junior residents found senior residents to be credible providers of feedback; however, they were reticent to find senior residents credible as assessors. CONCLUSIONS Although EPAs have formalized moments of feedback, senior residents struggled to include constructive feedback comments, all while knowing the assessment decisions may inform the overall summative decision of their peers. As a result, EPA ratings were often inflated. The utility of having senior residents serve as assessors needs to be reexamined because there is concern that this new role has taken away the benefits of having a senior resident act solely as a coach.
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Affiliation(s)
- James Rassos
- J. Rassos is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is professor, Department of Medicine, and scientist, Wilson Centre for Education, University of Toronto, Toronto, Ontario, Canada
| | - Renée E Stalmeijer
- R.E. Stalmeijer is assistant professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Lindsay J Melvin
- L.J. Melvin is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Long S, Rodriguez C, St-Onge C, Tellier PP, Torabi N, Young M. Factors affecting perceived credibility of assessment in medical education: A scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:229-262. [PMID: 34570298 DOI: 10.1007/s10459-021-10071-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
Assessment is more educationally effective when learners engage with assessment processes and perceive the feedback received as credible. With the goal of optimizing the educational value of assessment in medical education, we mapped the primary literature to identify factors that may affect a learner's perceptions of the credibility of assessment and assessment-generated feedback (i.e., scores or narrative comments). For this scoping review, search strategies were developed and executed in five databases. Eligible articles were primary research studies with medical learners (i.e., medical students to post-graduate fellows) as the focal population, discussed assessment of individual learners, and reported on perceived credibility in the context of assessment or assessment-generated feedback. We identified 4705 articles published between 2000 and November 16, 2020. Abstracts were screened by two reviewers; disagreements were adjudicated by a third reviewer. Full-text review resulted in 80 articles included in this synthesis. We identified three sets of intertwined factors that affect learners' perceived credibility of assessment and assessment-generated feedback: (i) elements of an assessment process, (ii) learners' level of training, and (iii) context of medical education. Medical learners make judgments regarding the credibility of assessments and assessment-generated feedback, which are influenced by a variety of individual, process, and contextual factors. Judgments of credibility appear to influence what information will or will not be used to improve later performance. For assessment to be educationally valuable, design and use of assessment-generated feedback should consider how learners interpret, use, or discount assessment-generated feedback.
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Affiliation(s)
- Stephanie Long
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Christina St-Onge
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Nazi Torabi
- Science Collections, University of Toronto Libraries, Toronto, ON, Canada
| | - Meredith Young
- Institute of Health Sciences Education, McGill University, 1110 Pine Ave West, Montreal, QC, H3A 1A3, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
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Bearman M, Dracup M, Garth B, Johnson C, Wearne E. Learning to recognise what good practice looks like: how general practice trainees develop evaluative judgement. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:215-228. [PMID: 34859317 DOI: 10.1007/s10459-021-10086-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
The nature of healthcare means doctors must continually calibrate the quality of their work within constantly changing standards of practice. As trainees move into working as fully qualified professionals, they can struggle to know how well they are practising in the absence of formal oversight. They therefore need to build their evaluative judgement: their capability to interpret cues and messages from the clinical environment, allowing them to judge quality of practice. This paper explores how Australian general practice (GP) trainees develop their evaluative judgement. We interviewed 16 GPs, who had recently completed certification requirements, asking them how they managed complex learning challenges across their training trajectory. A thematic analysis was sensitised by conceptualisations of evaluative judgement and feedback for future practice. Findings are reported via three themes: sources of performance relevant information; sense-making about progress within complex learning challenges; and changing practice as evaluative judgement develops. Trainees actively sought to understand what quality practice looked like within complex and ambiguous circumstances but often found it difficult to calibrate their performance. While reflective practice was key to developing evaluative judgment, feedback conversations could provide significant opportunities for trainees and supervisors to co-construct meaning. A 'feedback community' was available for frequent instances where supervisors were absent or not regarded as entirely credible, although feedback conversations in themselves did not necessarily assist trainees to develop evaluative judgement. There is room for a more active role for supervisors in assisting trainees to consider how to independently make sense of learning cues.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Tower 2, Level 12, 727 Collins St, Docklands Melbourne, 3008, Australia.
| | - Mary Dracup
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Tower 2, Level 12, 727 Collins St, Docklands Melbourne, 3008, Australia
| | - Belinda Garth
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Caroline Johnson
- Eastern Victoria General Practice Training, Melbourne/Churchill, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Elisabeth Wearne
- Eastern Victoria General Practice Training, Melbourne/Churchill, Australia
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25
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Sawatsky AP, O'Brien BC, Hafferty FW. Autonomy and developing physicians: Reimagining supervision using self-determination theory. MEDICAL EDUCATION 2022; 56:56-63. [PMID: 34091940 DOI: 10.1111/medu.14580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
In this article, we address the question, 'What is the role of autonomy in physician development?' Medical education is a developmental process, and autonomy plays a motivational role in physician development. Calls for increased supervision of residents have raised concerns that the resulting decreased autonomy might interfere with resident development, leading the authors to explore the relationship between supervision and autonomy. The medical education literature posits a simple inverse relationship between supervision and autonomy. Within competency frameworks, autonomy is operationalised as independence and viewed as the end goal of training. Alternatively, there is emerging empirical literature describing autonomy and supervision as dynamic and developmental constructs and point towards more complex relationship between supervision and autonomy. Self-determination theory (SDT) presents a framework for understanding this dynamic relationship and the role of autonomy in physician development. Within SDT, autonomy is a fundamental psychological need, associated with motivation for learning, self-regulation and an internal locus of control. Supporting learner autonomy can afford learners the opportunity to internalise the values and norms of the profession, leading to an integrated regulation of their behaviours and actions. Conceptualising autonomy through the lens of SDT provides an avenue for education interventions and future research on supervision and autonomy. Educators can integrate supervision and autonomy support in the clinical setting, seeking to motivate learner development by balancing optimal challenge and support and integrating autonomy support with 'hands-on' approaches to supervision. SDT also provides a theoretical framework relevant to current discussions regarding feedback conversations and coaching in medical education. Lastly, conceptualising autonomy using SDT opens new avenues for investigation, exploring the complex relationship between supervision and autonomy and developing efforts to integrate autonomy support with clinical supervision.
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Affiliation(s)
- Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
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26
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Bindels E, van den Goor M, Scherpbier A, Lombarts K, Heeneman S. Sharing Reflections on Multisource Feedback in a Peer Group Setting: Stimulating Physicians' Professional Performance and Development. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1449-1456. [PMID: 33951680 DOI: 10.1097/acm.0000000000004142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Reflecting on and using feedback are important for physicians' continuous professional development (CPD). A common format is the discussion of multisource feedback (MSF) in a one-on-one session with a trusted peer or coach. A new approach is to discuss MSF during a peer group session moderated by a professional facilitator. This qualitative study explored how physicians experience participation in these peer group sessions in the context of their CPD. METHOD Between March and July 2018, 26 physicians were interviewed about their experiences in a peer group session. These physicians represented 13 monospecialty physician groups from 5 general hospitals in the Netherlands. Interviews were transcribed verbatim and analyzed iteratively, following the interpretative phenomenological approach. RESULTS Participation was experienced as a process of disclosing and sharing personal reflections with peers while striking a balance between interpersonal proximity to and distance from peers. Sharing reflections with peers rendered the feedback more meaningful, deepened collegial relationships, and created a sense of urgency for improvement. Improvement goals were mostly related to relational fine-tuning in collaboration; goals related to individual career management remained in the background. Influential factors for the perceived effectiveness of the group sessions were related to the facilitator's expertise, group size, continuity and quality of collegial relationships, personal vulnerabilities, and the context of CPD policy. CONCLUSIONS Peer group sessions offered interactivity and established a clear link between individual physicians and their work environments. Sharing reflections on MSF in a peer group setting provided physicians with nuanced insight into their professional performance and fostered a community spirit that supported the implementation of intended changes. Future research should focus on the role of group dynamics and communication strategies and the application of coaching principles, such as drawing up a detailed plan of action and monitoring the follow-up process.
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Affiliation(s)
- Elisa Bindels
- E. Bindels was a PhD candidate, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands, and Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, at the time of the study. The author is now a lecturer, Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0001-6096-4950
| | - Myra van den Goor
- M. van den Goor is CEO, Q3 Company for Physician Development, Den Bosch, the Netherlands; ORCID: https://orcid.org/0000-0002-6361-0178
| | - Albert Scherpbier
- A. Scherpbier is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-9652-0163
| | - Kiki Lombarts
- K. Lombarts is professor, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
| | - Sylvia Heeneman
- S. Heeneman is professor, Department of Pathology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-6103-8075
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Huffman BM, Hafferty FW, Bhagra A, Leasure EL, Santivasi WL, Sawatsky AP. Resident impression management within feedback conversations: A qualitative study. MEDICAL EDUCATION 2021; 55:266-274. [PMID: 32815152 DOI: 10.1111/medu.14360] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Medical education is moving to conceptualise feedback as a bidirectional learning conversation. Within this conversation, learners experience a tension between assessment and feedback. That perceived tension affects learners' outward performances. In this study, we aimed to characterise residents' experiences with this tension and its effect on learner authenticity within feedback conversations. METHODS In this constructivist grounded theory study, the authors were informed by Goffman's theory of impression management. During data analysis, Dweck's theory of mindset was adopted. The authors conducted semi-structured interviews with 15 internal medicine residents. Data collection and analysis were conducted iteratively, using constant comparison to identify themes coinciding with impression management and mindset, ultimately developing a theoretical model to help explain residents' responses to tensions within feedback conversations. RESULTS Residents constantly felt 'scrutinized', and this affected their engagement in feedback conversations. They staged a performance within those conversations, linked to their underlying mindset: growth or fixed. Growth mindset was characterised by a focus on development as a physician and was associated with asking questions and seeking opportunities for growth. Fixed mindset was characterised by a focus on achieving a favourable evaluation and was associated with a hesitation to ask questions when faced with uncertainty and admit opportunities for growth, because they were concerned about impression management. Context influenced mindset and impression management. Residents adopted a fixed mindset and managed impressions when they perceived the permanence or consequences of evaluations within feedback. Residents adopted a growth mindset when they trusted the supervisor. DISCUSSION Residents assess the context of feedback conversations, altering the authenticity of their behaviours. Context, including the perceptions of formal assessment and relationships with supervisors, affected residents' mindset and impression management. Providing space for relationship-building and clarifying the purpose and structure of assessment may be helpful in supporting effective learning conversations in graduate medical education.
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Affiliation(s)
| | | | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emily L Leasure
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wil L Santivasi
- Division of Hospice and Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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28
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Lockyer J. In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context. J Grad Med Educ 2020; 12:27-35. [PMID: 32089791 PMCID: PMC7012514 DOI: 10.4300/jgme-d-19-00508.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The R2C2, a 4-phase feedback and coaching model, builds relationships, explores reactions, determines content and coaches for change, and facilitates formal feedback conversations between clinical supervisors/preceptors and residents. Formal discussions about performance are typically based on collated information from daily encounter sheets, objective structured clinical examinations, multisource feedback, and other data. This model has not been studied in settings where brief feedback and coaching conversations occur immediately after a specific clinical experience. OBJECTIVE We explored how supervisors adapt the R2C2 model for in-the-moment feedback and coaching and developed a guide for its use in this context. METHODS Eleven purposefully selected supervisors were interviewed in 2018 to explore where they used the R2C2 model, how they adapted it for in-the-moment conversations, and phrases used corresponding to each phase that could guide design of a new R2C2 in-the-moment model. RESULTS Participants readily adapted the model to varied feedback situations; each of the 4 phases were relevant for conversations. Phase-specific phrases that could enable effective coaching conversations in a limited amount of time were identified. Data facilitated a revision of the original R2C2 model for in-the-moment feedback and coaching conversations and design of an accompanying trifold brochure to enable its effective use. CONCLUSIONS The R2C2 in-the-moment model offers a systematic approach to feedback and coaching that builds on the original model, yet addresses time constraints and the need for an iterative conversation between the reaction and content phases. The model enables supervisors to coach and co-create an action plan with residents to improve performance.
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