Pedram Kimberly, Brooks Michelle N, Marcelo Carolyn, Kurbanova Nargiza, Paletta-Hobbs Laura, Garber Adam M, Wong Alice, Qayyum Rehan
Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA.
Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA.
Cureus. 2020 Feb 22;12(2):e7076. doi: 10.7759/cureus.7076.
Background Medical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors. Methods This study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after observation. The tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment. Teaching hospitalists were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Furthermore, we utilized a post-observation survey to assess the teaching and observing hospitalists' comfort with observation and the usefulness of the feedback. We used mixed linear models with crossed design to account for correlations between the observations. Models were adjusted for gender, age, and years of experience. We tested the internal validity of the instrument with Cronbach's alpha. Results Seventy (range: one to four observations per faculty) observations were performed involving 27 teaching attendings. A high proportion of teachers were comfortable with the observation (79%) and found the feedback helpful (92%), and useful for their own teaching (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach's alpha of 0.81 showing high internal validity. Conclusions Peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution.
背景 医学培训依赖于直接观察和形成性反馈。住院医师毕业后，获得临床教学反馈的机会减少。虽然通过学习者评估进行反馈很常见，但这些评估可能不及时、不具体且可能存在偏差。另一方面，小组环境或讲座形式的同行反馈已被证明对教学行为有益，然而，使用标准化工具进行同行观察并随后给出反馈是否会改善教学行为却鲜为人知。因此，本研究的目的是检验同行观察后的反馈是否会改善住院患者教学行为。方法 本研究在一家三级医疗医院进行。医院医学科的学术住院医师基于斯坦福教师发展计划开发了一个包含28个项目的标准化同行观察工具，用于在床边教学查房期间观察同行，并在观察后及时提供反馈。该工具聚焦于与住院患者教学环境相关的五个教学领域（学习氛围、课程把控、促进理解与记忆、评估和反馈）。教学住院医师在为期两周的教学轮转开始时接受观察、得到反馈，然后在轮转结束时再次接受观察。此外，我们利用观察后调查来评估教学和观察的住院医师对观察的舒适度以及反馈的有用性。我们使用交叉设计的混合线性模型来考虑观察之间的相关性。模型针对性别、年龄和经验年限进行了调整。我们用克朗巴哈系数检验了该工具的内部效度。结果 共进行了70次观察（范围：每位教员1至4次观察），涉及27位教学主治医师。很大一部分教师对观察感到满意（79%），认为反馈有帮助（92%），且对自身教学有用（88%）。教学行为领域的平均得分在2.1至2.7之间。在未调整和调整后的分析中，每次教学观察后，学习氛围（调整后改善 = 0.09；95%置信区间 = 0.02 - 0.15；p = 0.007）和促进理解与记忆（调整后改善 = 0.09；95%置信区间 = 0.02 - 0.17；p = 0.01）方面的得分更高。标准化观察工具的克朗巴哈系数为0.81，显示出较高的内部效度。结论 使用标准化工具进行床边教学的同行观察并随后给出反馈是可行的，且能带来理想教学行为的显著改善。这种方法的成功促使同行观察扩展到我们机构内科的其他科室。
