title: Content and timing of feedback and reflection: a multi-center qualitative study of experienced bedside teachers.
abstract: BACKGROUND
  Competency-based medical education increasingly recognizes the importance of observation, feedback, and reflection for trainee development. Although bedside rounds provide opportunities for authentic workplace-based implementation of feedback and team-based reflection strategies, this relationship has not been well described. The authors sought to understand the content and timing of feedback and team-based reflection provided by bedside teachers in the context of patient-centered bedside rounds.
  
  
  METHODS
  The authors conducted a thematic analysis qualitative study using transcripts from audio-recorded, semi-structured telephone interviews with internal medicine attending physicians (n= 34) identified as respected bedside teachers from 10 academic US institutions (2010-2011).
  
  
  RESULTS
  Half of the respondents (50%) were associate/full professors, with an average of 14 years of academic experience. In the context of bedside encounters, bedside teachers reported providing feedback on history-taking, physical-examination, and case-presentation skills, patient-centered communication, clinical decision-making, leadership, teaching skills, and professionalism. Positive feedback about physical-exam skills or clinical decision-making occurred during encounters, positive or constructive team-based feedback occurred immediately following encounters, and individualized constructive feedback occurred in one-on-one settings following rounding sessions. Compared to less frequent, emotionally-charged events, bedside teachers initiated team-based reflection on commonplace "teachable moments" related to patient characteristics or emotions, trainee actions and emotions, and attending physician role modeling.
  
  
  CONCLUSIONS
  Bedside teachers use bedside rounds as a workplace-based method to provide assessment, feedback, and reflection, which are aligned with the goals of competency-based medical education. Embedded in patient-centered activities, clinical teachers should be encouraged to incorporate these content- and timing-related feedback and reflection strategies into their bedside teaching.
authors.affiliation: Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA. jgonzalo@hmc.psu.edu.
authors.forename: Jed D
authors.initials: JD
authors.lastname: Gonzalo
authors.forename: Brian S
authors.initials: BS
authors.lastname: Heist
authors.forename: Briar L
authors.initials: BL
authors.lastname: Duffy
authors.forename: Liselotte
authors.initials: L
authors.lastname: Dyrbye
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Fagan
authors.forename: Gary
authors.initials: G
authors.lastname: Ferenchick
authors.forename: Heather
authors.initials: H
authors.lastname: Harrell
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hemmer
authors.forename: Walter N
authors.initials: WN
authors.lastname: Kernan
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
authors.forename: Colleen
authors.initials: C
authors.lastname: Rafferty
authors.forename: Raymond
authors.initials: R
authors.lastname: Wong
authors.forename: Michael D
authors.initials: MD
authors.lastname: Elnicki
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003162:Competency-Based Education; D005180:Faculty, Medical; D005246:Feedback; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018802:Patient-Centered Care; D014481:United States