Application of the R2C2 Model to In-the-Moment Feedback and Coaching.

Purpose: The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use.

Method: A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor-learner dyads.

'Change talk' among physicians in small group learning communities: An ethnographic study.

Introduction: Physicians face uncertainties in complex clinical environments. Small group learning initiatives allow physicians to decipher new evidence and address challenges. This study aimed to understand how physicians in small learning groups discuss, interpret and assess new evidence-based information to make decisions for practice.

Only When They Seek: Exploring Supervisor and Resident Perspectives and Positions on Upward Feedback.

Introduction: Verbal feedback from trainees to supervisors is rare in medical education, although valuable for improvement in teaching skills. Research has mostly examined narrative comments on resident evaluations of their supervisors. This study aimed to explore supervisors' and residents' beliefs and experiences with upward feedback, along with recommendations to initiate and facilitate effective conversations.

Physician engagement in regularly scheduled rounds.

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.

Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians' perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.

Results: Physician engagement in RSS was affected by four major themes: in RSS.

Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness-implementation randomised controlled trial.

Introduction: In response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called 'KeepWell' that supports seniors with complex care needs in their homes.

Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review.

Introduction: Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD.

Toward Practice-Based Continuing Education Protocols: Using Testing to Help Physicians Update Their Knowledge.

Introduction: Using assessment to facilitate learning is a well-established priority in education but has been associated with variable effectiveness for continuing professional development. What factors modulate the impact of testing in practitioners are unclear. We aimed to improve capacity to support maintenance of competence by exploring variables that influence the value of web-based pretesting.

In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context.

Background: The R2C2, a 4-phase feedback and coaching model, builds relationships, explores reactions, determines content and coaches for change, and facilitates formal feedback conversations between clinical supervisors/preceptors and residents. Formal discussions about performance are typically based on collated information from daily encounter sheets, objective structured clinical examinations, multisource feedback, and other data. This model has not been studied in settings where brief feedback and coaching conversations occur immediately after a specific clinical experience.

Academic Half-Days: Facilitated Small Groups to Promote Interactive Learning.

Background And Objectives: Medical educators have expressed interest in using less didactic and more interactive formats for academic half-days (AHDs) in postgraduate residency training. We assessed the feasibility and effectiveness of implementing a practice-based small-group learning (PBSGL) process as one part of AHDs.

Methods: A mixed-methods approach was used.

Identifying coaching skills to improve feedback use in postgraduate medical education.

Objectives: Coaching in medical education has recently gained prominence, but minimal attention has been given to key skills and determining how they work to effectively ensure residents are progressing and developing self-assessment skills. This study examined process-oriented and content-oriented coaching skills used in coaching sessions, with particular attention to how supervisors use them to enhance resident acceptance of feedback to enhance learning.

Methods: This qualitative study analysed secondary audiotaped data from 15 supervisors: resident dyads during two feedback sessions, 4 months apart.

The Calgary Audit and Feedback Framework: a practical, evidence-informed approach for the design and implementation of socially constructed learning interventions using audit and group feedback.

Background: Audit and feedback interventions may be strengthened using social interaction. The Calgary office of the Alberta Physician Learning Program (CPLP) developed a process for audit and group feedback for physicians. This paper extends previous work in which we developed a conceptual model of physician responses to audit and group feedback based on a qualitative analysis of six audit and group feedback sessions.

How do physicians behave when they participate in audit and feedback activities in a group with their peers?

Background: Audit and feedback interventions may be strengthened using social interaction. With this in mind, the Calgary office of the Alberta Physician Learning Program developed a process for audit and group feedback for physician groups. As a part of a larger project to develop a practical approach to the design and implementation of audit and group feedback projects, we explored patterns of physician behavior during facilitated audit and group feedback sessions.

How do clinicians use implementation tools to apply breast cancer screening guidelines to practice?

Background: Implementation tools (iTools) may enhance uptake of guidelines. However, little evidence exists on their use by primary care clinicians. This study explored which iTools clinicians used and how often; how satisfied clinicians were with the tools; whether tool use was associated with practice changes; and identified mediators for practice change(s) related to breast cancer screening (BCS).

The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use?

Purpose: The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use.

Knowledge translation of an online tool to determine candidacy for epilepsy surgery evaluation.

Background: Guidelines recommend that surgery be considered in patients with drug-resistant epilepsy, yet delays to epilepsy surgery still exist. A Web-based, evidence-informed clinical decision tool (www.toolsforepilepsy.

Encouraging Reflection and Change in Clinical Practice: Evolution of a Tool.

This article describes the systematic development and gradual transformation of a tool to guide participants in a continuing medical education program to reflect on their current practices and to make commitments to change. The continuous improvement of this tool was influenced by evolving needs of the program, reviews of relevant educational literature, feedback from periodic program surveys, interviews with group facilitators, and results from educational research studies. As an integral component of the educational process used in the Practice Based Small Group Learning Program, the current tool is designed to help family physicians think about what has been learned during each educational session and examine issues related to the implementation of evidence-based changes into their clinical practice.

Is the Cognitive Complexity of Commitment-to-Change Statements Associated With Change in Clinical Practice? An Application of Bloom's Taxonomy.

Introduction: This study categorizes 4 practice change options, including commitment-to-change (CTC) statements using Bloom's taxonomy to explore the relationship between a hierarchy of CTC statements and implementation of changes in practice. Our hypothesis was that deeper learning would be positively associated with implementation of planned practice changes.

Methods: Thirty-five family physicians were recruited from existing practice-based small learning groups.

Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2).

Purpose: To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback.

Method: To develop the feedback model (2011-2013), the authors drew on earlier research which highlights not only the factors that influence giving, receiving, accepting, and using feedback but also the theoretical perspectives which enable the understanding of these influences. The authors undertook an iterative, multistage, qualitative study guided by two recognized research frameworks: the UK Medical Research Council guidelines for studying complex interventions and realist evaluation.

Virtual patient activity patterns for clinical learning.

Background: Virtual patients are software tools that present learners with patient case situations and tasks. Some virtual patients take the learner through a guided case scenario, whereas others require learners to make diagnostic and therapeutic decisions. Much attention has been paid to the design of virtual patients and their use as standalone activities, but rather less attention has been paid to their use in broader educational activities.

Affordances of knowledge translation in medical education: a qualitative exploration of empirical knowledge use among medical educators.

Purpose: Little is known about knowledge translation processes within medical education. Specifically, there is scant research on how and whether faculty incorporate empirical medical education knowledge into their educational practices. The authors use the conceptual framework of affordances to examine factors within the medical education practice environment that influence faculty utilization of empirical knowledge.

Study protocol for a pilot study to explore the determinants of knowledge use in a medical education context.

Rationale, Aims And Objectives: While the science of knowledge translation (KT) has been growing steadily for the past decade in relation to understanding processes and actions which are embedded within clinical practice settings, little is known about how empirical knowledge is used within the medical education system. Despite an increase of research in this domain, we know very little about the contribution of this evidence in the development of medical students into effective physicians. This pilot study aims to: provide a synthesis of the evidence for educational strategies within medical education; explore the perceptions and experiences of faculty in undergraduate (UG) medical education in relation to their use of evidence in their educational practices; and illuminate how medical education evidence is formally integrated into a UG medical curriculum.

Tensions in informed self-assessment: how the desire for feedback and reticence to collect and use it can conflict.

Purpose: Informed self-assessment describes the set of processes through which individuals use external and internal data to generate an appraisal of their own abilities. The purpose of this project was to explore the tensions described by learners and professionals when informing their self-assessments of clinical performance.

Method: This 2008 qualitative study was guided by principles of grounded theory.