Lockyer Jocelyn, Armson Heather, Könings Karen D, Lee-Krueger Rachelle C W, des Ordons Amanda Roze, Ramani Subha, Trier Jessica, Zetkulic Mary Grace, Sargeant Joan
J Grad Med Educ. 2020 Feb;12(1):27-35. doi: 10.4300/JGME-D-19-00508.1.
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.
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.
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.
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.
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.
R2C2是一种四阶段反馈与指导模型，用于建立关系、探讨反应、确定内容并指导变革，促进临床督导/带教老师与住院医师之间进行正式的反馈对话。关于绩效的正式讨论通常基于日常情况记录表、客观结构化临床考试、多源反馈及其他数据整理的信息。该模型尚未在特定临床经验后立即进行简短反馈与指导对话的环境中进行研究。
我们探讨了督导如何调整R2C2模型以进行即时反馈与指导，并制定了在这种情况下使用该模型的指南。
2018年，我们对11名经过有目的挑选的督导进行了访谈，以了解他们在何处使用R2C2模型、如何针对即时对话对其进行调整，以及与每个阶段对应的可指导新的即时R2C2模型设计的用语。
参与者很容易将该模型应用于各种反馈情况；四个阶段中的每一个都与对话相关。我们确定了能够在有限时间内促成有效指导对话的特定阶段用语。这些数据有助于修订原始的R2C2模型，以用于即时反馈与指导对话，并设计了一份配套的三折页手册，以使其得到有效使用。
即时R2C2模型提供了一种系统的反馈与指导方法，它以原始模型为基础，但解决了时间限制以及反应阶段和内容阶段之间进行迭代对话的需求。该模型使督导能够与住院医师一起指导并共同制定行动计划，以提高绩效。
