title: Improving faculty feedback to resident trainees during a simulated case: a randomized, controlled trial of an educational intervention.
abstract: BACKGROUND
  Although feedback conversations are an essential component of learning, three challenges make them difficult: the fear that direct task feedback will harm the relationship with the learner, overcoming faculty cognitive biases that interfere with their eliciting the frames that drive trainees' performances, and time pressure. Decades of research on developmental conversations suggest solutions to these challenges: hold generous inferences about learners, subject one's own thinking to test by making it public, and inquire directly about learners' cognitive frames.
  
  
  METHODS
  The authors conducted a randomized, controlled trial to determine whether a 1-h educational intervention for anesthesia faculty improved feedback quality in a simulated case. The primary outcome was an analysis of the feedback conversation between faculty and a simulated resident (actor) by using averages of six elements of a Behaviorally Anchored Rating Scale and an objective structured assessment of feedback. Seventy-one Harvard faculty anesthesiologists from five academic hospitals participated.
  
  
  RESULTS
  The intervention group scored higher when averaging all ratings. Scores for individual elements showed that the intervention group performed better in maintaining a psychologically safe environment (4.3 ± 1.21 vs. 3.8 ± 1.16; P = 0.001), identifying and exploring performance gaps (4.1 ± 1.38 vs. 3.7 ± 1.34; P = 0.048), and they more frequently emphasized the professionalism error of failing to call for help over the clinical topic of anaphylaxis (66 vs. 41%; P = 0.008).
  
  
  CONCLUSIONS
  Quality of faculty feedback to a simulated resident was improved in the interventional group in a number of areas after a 1-h educational intervention, and this short intervention allowed a group of faculty to overcome enough discomfort in addressing a professionalism lapse to discuss it directly.
authors.affiliation: From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, and Center for Medical Simulation, Boston, Massachusetts.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Minehart
authors.forename: Jenny
authors.initials: J
authors.lastname: Rudolph
authors.forename: May C M
authors.initials: MC
authors.lastname: Pian-Smith
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Raemer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002983:Clinical Competence; D004342:Drug Hypersensitivity / Q000175:diagnosis; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement; D005178:Faculty; D005246:Feedback; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D007858:Learning; D008297:Male; D019300:Medical Errors; D008606:Mental Processes; D015588:Observer Variation; D016544:Patient Simulation; D024382:Professional Role; D012106:Research; D013663:Teaching
chemical_list: D000900:Anti-Bacterial Agents