住院医师规范化培训中的 R2C2 模式：它如何促进辅导和促进反馈的使用？
The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use?
机构信息
J. Sargeant is professor, Continuing Professional Development Program and Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. J.M. Lockyer is professor, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. H. Armson is assistant dean, Continuing Professional Development, and associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. A. Warren is associate professor, Department of Pediatrics, and associate dean, Postgraduate Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. M. Zetkulic is assistant professor, Seton Hall School of Medicine, Director of Medical Education, Department of Medicine, Hackensack University Hospital, Hackensack, New Jersey. S. Soklaridis is assistant professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. K.D. Könings is associate professor, Department of Educational Development & Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. K. Ross is research associate, Department of Evaluation, Research and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. I. Silver is vice president of education, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E. Holmboe is senior vice president of milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor of medicine, Yale University, New Haven, Connecticut, and adjunct professor, Uniformed Services University of the Health Sciences, Bethesda, Maryland. C. Shearer is evaluation specialist, Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada. M. Boudreau is evaluation specialist, Continuing Professional Development, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
Acad Med. 2018 Jul;93(7):1055-1063. doi: 10.1097/ACM.0000000000002131.
PURPOSE
The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use.
METHOD
From July 2014-October 2016, case study methodology was used to study R2C2 model use and the influence of context on use within and across five cases. Five residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesia) from three countries (Canada, the United States, and the Netherlands) were recruited. Data collection included audiotaped site assessment interviews, feedback sessions, and debriefing interviews with residents and supervisors, and completed learning change plans (LCPs). Content, thematic, template, and cross-case analysis were conducted.
RESULTS
An average of nine resident-supervisor dyads per site were recruited. The R2C2 feedback model, used with an LCP, was reported to be effective in engaging residents in a reflective, goal-oriented discussion about performance data, supporting coaching, and enabling collaborative development of a change plan. Use varied across cases, influenced by six general factors: supervisor characteristics, resident characteristics, qualities of the resident-supervisor relationship, assessment approaches, program culture and context, and supports provided by the authors.
CONCLUSIONS
The R2C2 model was reported to be effective in fostering a productive, reflective feedback conversation focused on resident development and in facilitating collaborative development of a change plan. Factors contributing to successful use were identified.
目的
作者先前开发并测试了一个促进实践改进绩效反馈的反思模型，即 R2C2 模型。它由四个阶段组成：关系建立、探索反应、探索内容和指导。本研究研究了该模型在不同住院医师培训计划中的使用情况和有效性，以及影响其有效性和使用的因素。
方法
从 2014 年 7 月至 2016 年 10 月，采用案例研究方法研究了 R2C2 模型的使用情况以及背景对不同案例中使用的影响。从三个国家（加拿大、美国和荷兰）招募了五个住院医师培训计划（家庭医学、精神病学、内科、外科和麻醉学）。数据收集包括对居民和主管进行录音现场评估访谈、反馈会议和汇报访谈，以及完成学习变化计划（LCP）。进行了内容分析、主题分析、模板分析和跨案例分析。
结果
每个地点平均招募了 9 对居民-主管。报告称，使用 LCP 的 R2C2 反馈模型在使居民参与关于绩效数据的反思性、目标导向的讨论、支持指导以及使协作制定变更计划方面非常有效。使用情况因案例而异，受到六个一般因素的影响：主管特征、居民特征、居民-主管关系的质量、评估方法、计划文化和背景以及作者提供的支持。
结论
报告称，R2C2 模型在促进以居民发展为重点的富有成效的反思性反馈对话和促进变更计划的协作制定方面非常有效。确定了促成成功使用的因素。
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