The Challenge of Critical Feedback: A simulation-based Advanced Residents as Teachers Module

ABSTRACT: Audience: This is a simulation module intended to train residents at all levels in giving targeted, critical feedback to medical students on shift. Introduction: Residents as teachers (RAT) curricula are an important component of graduate medical education for residents who teach medical students.1 Developing residents’ skills in teaching, feedback, and supervision is therefore a critical component of training. Medical students receive a substantial portion of their clinical education from residents,2,3and timely, specific feedback in the clinical setting improves learner performance and professional development.4 Despite the importance of these skills, residents have limited opportunities to practice delivering challenging feedback beyond introductory teaching experiences.5,6 This curriculum addresses that gap by providing simulation-based practice in identifying learner gaps and delivering targeted, critical feedback to medical students. Educational Objectives: The purpose of this module was to provide a safe learning environment for residents to practice giving critical feedback to medical students. By the end of the session, residents will be able to 1) identify gaps in student proficiency through analysis of a simulated student’s clinical performance as demonstrated by a simulated case presentation, 2) formulate specific feedback for student learners to target identified gaps, and 3) apply a newly learned strategy for providing feedback to a “student” during two simulation-based communication cases. Educational Methods: We developed two simulation communication cases wherein resident participants of all training years were placed in the roles of a simulated medical student and a simulated resident. Both roles are structured for resident participants only and the simulated student role was performed by another resident before the roles were then switched for the second case. This educational session was held in small groups during resident didactics with a facilitator present with each of the small group sessions. The first case involves a presentation of a patient with leg pain with an underlying diagnosis of necrotizing fasciitis, and the second involves a presentation of a patient with chest pain with an underlying diagnosis of pulmonary embolism. Face sheet information gives the simulated student and simulated resident unexpectedly different perspectives, leading the simulated student to omit can’t-miss diagnoses and requiring the resident to recognize an opportunity for feedback and practice delivering teaching points. The simulated student, played by another resident, is also invited to provide comments to their partner on the teaching strategies used during a facilitator-led debrief following the completion of each case Research Methods: Twenty-one participants completed pre-and post- surveys to gauge comfort with teaching and providing feedback to medical students on shift. Participants ranked their perceived importance of a “Residents as Teachers” curriculum in their medical education. We used a paired t-test to assess the change in rating before and after the cases. Statistical calculations were done using Excel. Participants provided qualitative data through open-ended feedback comments. Results: Resident confidence in teaching medical students on shift increased from 3.65 to 3.9 (P=0.01), and confidence in giving critical feedback increased from 3.2 to 3.95 (P<0.001). The perceived importance of a “Residents as Teachers” curriculum was overall unchanged from 4.4 to 4.5 (P>0.2). Review of feedback comments demonstrated an overall positive experience and several requests to receive further training on effective teaching. One resident playing the role of a “student” shared that they felt it was particularly helpful to play the role of the student to understand their perspective better, and several comments included a request for further opportunities for practice in the future. One resident suggested providing additional teaching on how to approach teaching students of different levels of training Discussion: The utilization of these modules was well-received by participants and proved to be an effective way to improve resident comfort in providing critical feedback and teaching medical students on shift. Providing the simulated student and simulated resident with divergent clinical perspectives allowed for a nuanced discussion regarding how the residents felt in their individual roles and their perceived efficacy of the feedback provided to the simulated student. Residents communicated that the cases were reflective of experiences they have had on shift and appreciated the ability to practice their skills in a safe environment. They reported overall satisfaction with the cases and a desire to use similar cases in the future.