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

• Published in: BMC medical education Vol. 14; no. 1; p. 212
• Main Authors: Gonzalo, Jed D, Heist, Brian S, Duffy, Briar L, Dyrbye, Liselotte, Fagan, Mark J, Ferenchick, Gary, Harrell, Heather, Hemmer, Paul A, Kernan, Walter N, Kogan, Jennifer R, Rafferty, Colleen, Wong, Raymond, Elnicki, Michael D
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10-10-2014; BioMed Central
• Subjects: Accreditation; Adult; Attitude of Health Personnel; Clinical Competence; Competency-Based Education; Data Analysis; Education; Educational Development; Educational Strategies; Faculty Development; Faculty, Medical; Feedback; Female; Health sciences; Hospitals; Human subjects; Humans; Internal medicine; Internship and Residency; Interviews; Male; Medicine; Methods; Middle Aged; Patient Care Team; Patient-Centered Care; Physicians; Qualitative research; Studies; Teachers; Teaching; United States; University colleges; United States; United States > US; Minnesota; Pennsylvania
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/1472-6920-14-212

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.
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).
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.
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.