Content and timing of feedback and reflection: A multi-center qualitative study of experienced bedside teachers

Jed D. Gonzalo, Brian S. Heist, Briar L. Duffy, Liselotte Dyrbye, Mark J. Fagan, Gary Ferenchick, Heather Harrell, Paul A. Hemmer, Walter N. Kernan, Jennifer R. Kogan, Colleen Rafferty, Raymond Wong, Michael D. Elnicki

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Competency-based medical education increasingly recognizes the importance of observation, feedback, and reflection for trainee development. Although bedside rounds provide opportunities for authentic workplace-based implementation of feedback and team-based reflection strategies, this relationship has not been well described. The authors sought to understand the content and timing of feedback and team-based reflection provided by bedside teachers in the context of patient-centered bedside rounds.

Methods. The authors conducted a thematic analysis qualitative study using transcripts from audio-recorded, semi-structured telephone interviews with internal medicine attending physicians (n= 34) identified as respected bedside teachers from 10 academic US institutions (2010-2011).

Results: Half of the respondents (50%) were associate/full professors, with an average of 14 years of academic experience. In the context of bedside encounters, bedside teachers reported providing feedback on history-taking, physical-examination, and case-presentation skills, patient-centered communication, clinical decision-making, leadership, teaching skills, and professionalism. Positive feedback about physical-exam skills or clinical decision-making occurred during encounters, positive or constructive team-based feedback occurred immediately following encounters, and individualized constructive feedback occurred in one-on-one settings following rounding sessions. Compared to less frequent, emotionally-charged events, bedside teachers initiated team-based reflection on commonplace "teachable moments" related to patient characteristics or emotions, trainee actions and emotions, and attending physician role modeling.

Conclusions: Bedside teachers use bedside rounds as a workplace-based method to provide assessment, feedback, and reflection, which are aligned with the goals of competency-based medical education. Embedded in patient-centered activities, clinical teachers should be encouraged to incorporate these content- and timing-related feedback and reflection strategies into their bedside teaching.

Original languageEnglish (US)
Article number212
JournalBMC medical education
Volume14
Issue number1
DOIs
StatePublished - Oct 10 2014

Keywords

  • Medical education
  • Medical education-faculty development
  • Medical education-qualitative methods
  • Patient centered care

ASJC Scopus subject areas

  • Education

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    Gonzalo, J. D., Heist, B. S., Duffy, B. L., Dyrbye, L., Fagan, M. J., Ferenchick, G., Harrell, H., Hemmer, P. A., Kernan, W. N., Kogan, J. R., Rafferty, C., Wong, R., & Elnicki, M. D. (2014). Content and timing of feedback and reflection: A multi-center qualitative study of experienced bedside teachers. BMC medical education, 14(1), [212]. https://doi.org/10.1186/1472-6920-14-212