A qualitative study of resident learning in ambulatory clinic. The importance of exposure to 'breakdown' in settings that support effective response.

Qualitative analysis of a large ethnographic database from observations of a resident teaching clinic revealed three important findings. The first finding was that breakdown, a situation where an 'actor' (such as a person or the group) is not achieving expected effectiveness, was the most important category because of its frequency and explanatory power. The next finding was that exposure to breakdown was a necessary ingredient for reflective learning.

A Broader Theoretical Model for Feedback in Ambulatory Care.

Ask faculty if they provide feedback and they will likely reply "Sure, it's important, I do it all the time". Ask medical students if they receive feedback and they may say, "We hardly ever get it". Ask most residents if they receive feedback and you get "Rarely, but it's not that helpful anyway".