Ramani Subha, Armson Heather, Hanmore Tessa, Lee-Krueger Rachelle, Könings Karen D, Roze des Ordons Amanda, Zetkulic Marygrace, Sargeant Joan, Lockyer Jocelyn M
Harvard Medical School, MGH Institute for Health Professions Education, Boston, Massachusetts, US.
External Faculty, School of Health Professions Education, Maastricht University, NL.
Perspect Med Educ. 2025 Jan 17;14(1):9-19. doi: 10.5334/pme.1368. eCollection 2025.
Feedback literacy (FBL) is a critical skill for learners encompassing four behaviors: appreciating feedback, making judgements, managing affect, and taking action. Little guidance has been available for clinical preceptors to promote FBL. The R2C2 feedback and coaching model that guides teachers through building Relationships, exploring Reactions and Reflections, discussing Content and Coaching to co-develop an action plan for follow-up may support FBL. This study sought to identify whether R2C2 conversations operationalized FBL behaviors and the factors that appeared to influence FBL.
Based on data from a multi-institutional, qualitative study involving 15 dyads of learners (residents and medical students) and their physician preceptors, a secondary analysis of R2C2-guided feedback conversations and debriefing interviews was undertaken. A framework analysis mapped the data to FBL behaviors and explored factors that impacted behaviors in the context of the research and theories underpinning R2C2 and FBL.
Most elements of FBL behaviors were demonstrated in R2C2 conversations. Appreciating feedback and making judgements were most consistently noted. There was less evidence of managing affect as learners indicated acceptance of feedback. There was variability in the co-creation of action plans. Some created action plans, others had incomplete or no plan for immediate action or follow-up. FBL appeared to be impacted by learner-preceptor relationships, active learner engagement in feedback discussions, and personal characteristics.
Our analysis demonstrated that effective use of the R2C2 model could enhance FBL behaviors provided attention was paid to optimizing all phases of R2C2, particularly co-creation of action plans for follow-up.
反馈素养（FBL）是学习者的一项关键技能，包含四种行为：重视反馈、做出判断、管理情绪和采取行动。目前几乎没有为临床带教老师提供促进反馈素养的指导。R2C2反馈与指导模型通过建立关系、探索反应与反思、讨论内容和指导来共同制定后续行动计划，从而指导教师，这可能有助于反馈素养的提升。本研究旨在确定R2C2对话是否能落实反馈素养行为以及似乎影响反馈素养的因素。
基于一项多机构定性研究的数据，该研究涉及15对学习者（住院医师和医学生）及其医师带教老师，对R2C2指导的反馈对话和汇报访谈进行了二次分析。框架分析将数据映射到反馈素养行为，并在支撑R2C2和反馈素养的研究及理论背景下探索影响行为的因素。
反馈素养行为的大多数要素在R2C2对话中得到了体现。最常被提及的是重视反馈和做出判断。由于学习者表示接受反馈，因此管理情绪的证据较少。在共同制定行动计划方面存在差异。一些人制定了行动计划，另一些人则没有立即采取行动或后续跟进的完整计划或根本没有计划。反馈素养似乎受到学习者与带教老师关系、学习者积极参与反馈讨论以及个人特征的影响。
我们的分析表明，有效使用R2C2模型可以增强反馈素养行为，前提是要注意优化R2C2的各个阶段，特别是共同制定后续行动计划。
