Dr. Hoag thoroughly enjoys working with Penelope, one of the senior residents at his hospital. He admires her knowledge, diligence on shifts and involvement in academic pursuits. Outside of the hospital, Dr. Hoag has become a mentor to Penelope, and often offers career advice. One day, Dr. Hoag observes Penelope treat a difficult psychiatric patient, and Penelope uncharacteristically loses her cool and verbally lashes back at the patient. After the shift, Dr. Hoag wants to give feedback to Penelope, but finds it challenging because of their relationship. How can educators help Dr. Hoag?
Unlike many other specialties, Emergency Medicine shifts have a daily opportunity for preceptors to give one-on-one feedback to their learners. Therefore, it is important emergency physicians develop skills in addressing awkward topics and giving useful feedback. This “Great Evidence in Medical education Summary” (GEMeS – pronounced “gems”) was originally posted by the CAEP EWG GEMeS Team on March 20, 2015 and answers the question: “Does a one hour education session enable faculty to provide quality feedback to learners in a simulated setting?” A PDF version of the GEMeS summary is available here.
Education Question or Problem
THE EFFECTIVENESS OF DIRECT AND TIMELY FEEDBACK BY FACULTY TO LEARNERS IS OFTEN CHALLENGED BY FACULTY COGNITIVE BIASES, TIME CONSTRAINTS AND CONCERNS ABOUT HARMING THEIR RELATIONSHIP WITH THE LEARNER.
Minehart RD, Rudolph J, Pian-Smith MCM, Raemer DB.
Improving faculty feedback to resident trainees during a simulated case: A randomized, controlled trial of an educational intervention. Anesthesiology. 2014 Jan;120(1):160-71.
Randomized, controlled trial of an educational intervention
Foundation for Anesthesia Education and Research (FAER) Research in Education Grant (REG).
The Center for Medical Simulation. The study was conducted during a recurring, mandatory, simulation-based crisis management course for practicing anesthesiologists from five academic hospitals in greater Boston, Massachusetts.
Level of Learning
Practicing physicians: feedback was given to a simulated resident.
Synopsis of Study
The experimental case scenario consisted of two parts. The first part allowed the participant to observe a simulated resident commit four errors while managing a simulated patient. In the second part, the participant engaged in a feedback conversation with the resident about his/her performance.
Debriefing sessions were rated by four experienced, blinded raters, using both a behaviourally anchored rating scale (BARS) and an objective 12-point feedback assessment instrument to assess the style/pattern of feedback given. Average ratings for the intervention group were higher (4.2 ± 1.28) than the control group (3.8 ± 1.22; p < 0.0001) indicating better ability to maintain a psychologically safe environment while providing feedback, to structure the feedback session in an organized manner and to identify and explore performance gaps.
Specifically, participants in the intervention group were more likely to use a preview statement to commence the feedback session and they more commonly used advocacy/inquiry model of communication (see Figure 1). They less commonly used “guess what I am thinking” questioning. They were also more likely to address professionalism errors, while the control group tended to focus on clinical errors.
Why is it relevant to Emergency Medicine Education?
Does your institution train its faculty on feedback? One common CAEP teaching course is “ED STAT!”–have you found it (or other courses) to elevate the level of feedback you give?
More About the CAEP GEMeS
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Great Evidence in Medical Education Summaries (GEMeS) project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive GEMeS each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.