Through the Looking Glass: Comparing Hospitalists' and Internal Medicine Residents' Perceptions of Feedback.

Introduction: Feedback is critical for resident growth and is most effective when the relationship between residents and attendings is collaborative, with shared expectations for the purpose, timing, and manner of communication for feedback. Within internal medicine, there is limited work exploring the resident and hospitalist perspectives on whether key elements are included in feedback sessions.

Methods: We surveyed internal medicine residents and supervising hospitalists at a large urban training program about their perspectives on four components of effective feedback: specificity,timeliness, respectful communication, and actionability.

'Walking together': How relationships shape physicians' clinical reasoning.

Introduction: The clinical reasoning literature has increasingly considered context as an important influence on physicians' thinking. Physicians' relationships with patients, and their ongoing efforts to maintain these relationships, are important influences on how clinical reasoning is contextualised. The authors sought to understand how physicians' relationships with patients shaped their clinical reasoning.

An Embedded Curriculum to Teach Critical Incident Debriefing to Internal Medicine Residents.

Internal medicine residents frequently experience distressing clinical events; critical event debriefing is one tool to help mitigate their effects. To evaluate the effectiveness of a 1-hour workshop teaching residents a novel, efficient approach to leading a team debrief after emotionally charged clinical events. An internal needs assessment identified time and confidence as debriefing barriers.

Death Certification: An Interactive Teaching Session.

Introduction: Documentation of the cause of death is important for local and national epidemiology as well as for research and public health funding allocation. Despite this, many physicians lack the skills necessary to accurately complete a death certificate.

Methods: We created a 45-minute virtual workshop to improve skills in completing death certificates.

Deliberate practices of speaking up and responding skills: the Speak-PREP e-learning module for healthcare professionals.

Purpose: Speaking up and responding to others' concerns promotes patient safety. We describe health professionals' utilisation of these important skills.

Method: We developed an interactive e-learning module, Speak-PREP, to train healthcare professionals in speaking up and responding strategies.

Interprofessional Education Module on Post-Intensive Care Syndrome for Internal Medicine Residents.

Background: Prevention of post-intensive care syndrome (PICS) in critically ill patients requires interprofessional collaboration among physicians, physical therapists, occupational therapists, speech-language pathologists, and nutritionists. Interprofessional education promotes interprofessional collaborative practice, yet formalized interprofessional education during residency is uncommon.

Objective: We sought to improve internal medicine residents' knowledge of interprofessional roles in the intensive care unit (ICU) and confidence in managing PICS by designing a virtual multimodal training module.

Development and Implementation of a Complex Health System Intervention Targeting Transitions of Care from Hospital to Post-acute Care.

Background: Failure of effective transitions of care following hospitalization can lead to excess days in the hospital, readmissions, and adverse events. Evidence identifies both patient and system factors that influence poor care transitions, yet health systems struggle to translate evidence into complex interventions that have a meaningful impact on care transitions.

Objective: We report on our experience developing, pilot testing, and evaluating a complex intervention (Addressing Complex Transitions program, or ACT program) that aims to improve care transitions for complex patients.

"Not so fast!" the complexity of attempting to decrease door-to-floor time for emergency department admissions.

Background: Successful quality improvement is fundamental to high-performing health care systems, but becomes increasingly difficult as systems become more complex. Previous attempts at the University of California, San Francisco (UCSF) Medical Center to reduce door-to-floor (D2F) time -the time required to move an ill patient through the emergency department (ED) to an appropriate inpatient bed-had not resulted in meaningful improvement. An analysis of why attempts at decreasing D2F times in the ED had failed, with attention to contextual factors, yields recommendations on how to decrease D2F time.