Lafleur Alexandre, Côté Luc, Witteman Holly O
is Associate Clinical Professor, Department of Medicine, Laval University Faculty of Medicine, Quebec City, Canada, and Co-Chairholder, CMA-MD Educational Leadership Chair in Health Professions Education.
is Professor and Medical Education Researcher, Department of Family and Emergency Medicine, Office of Education and Continuing Professional Development, Laval University Faculty of Medicine, Quebec City, Canada.
J Grad Med Educ. 2021 Apr;13(2):246-256. doi: 10.4300/JGME-D-20-00842.1. Epub 2021 Apr 16.
Literature examining the feedback supervisors give to residents during case discussions in the realms of communication, collaboration, and professional roles (intrinsic roles) focuses on analyses of written feedback and self-reporting.
We quantified how much of the supervisors' verbal feedback time targeted residents' intrinsic roles and how well feedback time was aligned with the role targeted by each case. We analyzed the educational goals of this feedback. We assessed whether feedback content differed depending on whether the residents implied or explicitly expressed a need for particular feedback.
This was a mixed-methods study conducted from 2017 to 2019. We created scripted cases for radiology and internal medicine residents to present to supervisors, then analyzed the feedback given both qualitatively and quantitatively. The cases were designed to highlight the CanMEDS intrinsic roles of communicator, collaborator, and professional.
Radiologists (n = 15) spent 22% of case discussions providing feedback on intrinsic roles (48% aligned): 28% when the case targeted the communicator role, 14% for collaborator, and 27% for professional. Internists (n = 15) spent 70% of discussions on intrinsic roles (56% aligned): 66% for communicator, 73% for collaborator, and 72% for professional. Radiologists' goals were to offer advice (66%), reflections (21%), and agreements (7%). Internists offered advice (41%), reflections (40%), and clarifying questions (10%). We saw no consistent effects when residents explicitly requested feedback on an intrinsic role.
Case discussions represent frequent opportunities for substantial feedback on intrinsic roles, largely aligned with the clinical case. Supervisors predominantly offered monologues of advice and agreements.
关于上级在病例讨论中就沟通、协作和专业角色（内在角色）向住院医师提供反馈的文献，主要集中在对书面反馈和自我报告的分析上。
我们量化了上级口头反馈时间中有多少针对住院医师的内在角色，以及反馈时间与每个病例所针对的角色的匹配程度。我们分析了这种反馈的教育目标。我们评估了反馈内容是否因住院医师暗示或明确表达对特定反馈的需求而有所不同。
这是一项在2017年至2019年进行的混合方法研究。我们为放射科和内科住院医师编写了脚本病例，让他们向上级展示，然后对给出的反馈进行定性和定量分析。这些病例旨在突出CanMEDS的沟通者、协作者和专业人员等内在角色。
放射科医生（n = 15）在病例讨论中花费22%的时间就内在角色提供反馈（匹配度为48%）：当病例针对沟通者角色时为28%，针对协作者时为14%，针对专业人员时为27%。内科医生（n = 15）在讨论中花费70%的时间在内在角色上（匹配度为56%）：针对沟通者为66%，针对协作者为73%，针对专业人员为72%。放射科医生的目标是提供建议（66%）、反思（21%）和达成共识（7%）。内科医生提供建议（41%）、反思（40%）和澄清问题（10%）。当住院医师明确要求就内在角色提供反馈时，我们没有看到一致的效果。
病例讨论是就内在角色进行大量反馈的常见机会，在很大程度上与临床病例相匹配。上级主要提供建议和达成共识的独白。
