Encouraging Reflexivity in a Residency Leadership Development Program: Expanding Outside the Competency Approach

Clapp, Justin T.; Gordon, Emily K.; Baranov, Dimitry; Trey, Beulah; Tilin, Felice; Fleisher, Lee A.

doi:10.1097/acm.0000000000001915

Cited by 8 publications

(9 citation statements)

References 10 publications

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“…28 There are also organizations and departments that have created and/or implemented programs to improve various aspects of peer support. [29][30][31][32] While there is value in distal (or "cold") 33 debriefing once members have been able to process an event, it does not remove the potential value of proximal debriefing. "Hot" debriefing has been described in the critical care literature as "tak[ing] place soon, often immediately, after the resuscitation attempt."…”

Section: Discussionmentioning

confidence: 99%

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event

et al. 2019

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Background: Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors' objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel.Methods: At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings.Results: During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers.conclusions: Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief. (ANESTHESIOLOGY 2019; 130:1039-48) EditoR'S PERSPEctiVE What We Already Know about This Topic• Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. What This Article Tells us That Is New• Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief. . Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology's articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.anEStHESioLoGY REFLEctionS FRoM tHE Wood LiBRaRY-MuSEuM

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Section: Discussionmentioning

confidence: 99%

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event

et al. 2019

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“…Residents expressed humility, recognizing that most supervisors have something to offer and demonstrating self-awareness of their roles in training programs. As junior colleagues in a hierarchical medical education culture [33], they often found discarding feedback uncomfortable.…”

Section: Reluctance To Discard Feedbackmentioning

confidence: 99%

“Maybe it’s the first time somebody’s been honest with you”: exploring how residents reconcile feedback variability

2022

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Background Supervisors in postgraduate medical education may deliver different feedback for the same quality of performance. Residents may struggle to make sense of inconsistent and sometimes contradictory information. We sought to explore how residents experience feedback from different supervisors, how they process inconsistent information, and what factors influence their experiences. Methods Eighteen residents participated in semi-structured interviews to explore their perspectives on feedback. Using a constructivist grounded theory approach, we engaged in iterative cycles of data collection and analysis, sampling until theoretical sufficiency was reached. Constant comparative analysis was used to identify and define themes.Results We identified a central theme of reconciliation, which we defined as the act of processing inconsistent feedback and determining how to engage with it. This reconciliation was informed by the credibility of, and residents' relationship with, supervisors and was achieved through conversations with peers and mentors, observation of other supervisors' behavior toward their performance, and reflection on their own performance. Participants expressed a reluctance to discard feedback, even if they felt it was incongruent with previous feedback or their own self-concept and self-assessment. ConclusionThe findings of this study show that while residents are regular consumers of feedback, not all feedback is used equally. Residents actively reconcile sometimes-contradictory feedback and must work to balance a general reluctance to discard feedback, while developing an understanding of its credibility. This work reinforces the importance of pedagogical relationships and identifies that facilitated reflection that explicitly acknowledges feedback inconsistencies may be important in the reconciliation process. Keywords Medical education • Feedback • Supervision • Residents RésuméContexte Les superviseurs dans l'enseignement médical postdoctorale peuvent fournir un feedback différent pour la même qualité de performance. Les résidents peuvent avoir du mal à donner un sens à des informations incohérentes et parfois contradictoires. Nous avons cherché à explorer la façon dont les résidents vivent le feedback de différents superviseurs, comment ils traitent les informations incohérentes et quels facteurs influencent leurs expériences. Méthodes Dix-huit résidents ont participé à des entretiens semi-structurés pour explorer leur point de vue sur le retour d'information. À l'aide d'une approche fondée sur une théorie constructiviste, nous sommes engagés dans des cycles itératifs * Kaif Pardhan

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“…4,5 Residents' and attendings' differing goals also compromise feedback quality: while residents need feedback to correct deficiencies in practice, many attendings feel that residents are not receptive to feedback and fear repercussions if they provide negative comments. 3,6,7 Relative to other medical settings, the operating room (OR) is a uniquely challenging environment for delivering and receiving formative feedback. The OR is a fast-paced environment with space and privacy limitations and frequent rotation of residents between different attending supervisors.…”

Section: Problemmentioning

confidence: 99%

“…Emphasizing the value of adaptability to residents, while preparing attendings to nurture that adaptability through recognizing the learning challenges posed by OR workflow, can enhance collaboration and bridge residentattending discrepancies in feedback satisfaction. [3][4][5] Collaboration can also be encouraged by engaging in focused goal setting before working together so residents and attendings can make feedback interactions more specific and actionable by directing them toward established objectives-for example, a new clinical technique-while helping residents reflect on areas of weakness and actively participate in their efforts toward improvement.…”

Section: Residents React To Feedback Perceived As Excessively Negativementioning

confidence: 99%

Improving Formative Feedback in the Operating Room Setting: Developing and Implementing an Initiative to Improve Feedback Quality and Culture

et al. 2021

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Encouraging Reflexivity in a Residency Leadership Development Program: Expanding Outside the Competency Approach

Abstract: Further work is necessary to describe how leadership program formats can be diversified to better encourage reflexivity. There is also a need to develop mechanisms for assessing outcomes of leadership programs that expand outside the competency-based system.

Cited by 8 publications

References 10 publications

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event

“Maybe it’s the first time somebody’s been honest with you”: exploring how residents reconcile feedback variability

Improving Formative Feedback in the Operating Room Setting: Developing and Implementing an Initiative to Improve Feedback Quality and Culture

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