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1.  Content and timing of feedback and reflection: a multi-center qualitative study of experienced bedside teachers 
BMC Medical Education  2014;14(1):212.
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.
doi:10.1186/1472-6920-14-212
PMCID: PMC4198734  PMID: 25304386
Medical education-qualitative methods; Medical education; Medical education-faculty development; Patient centered care
2.  Educational and Career Outcomes of an Internal Medicine Preceptorship for First-Year Medical Students 
OBJECTIVE
Medical educators have attempted in recent years to provide quality clinical experiences for medical students early in their medical training. We questioned whether participating in a preceptorship in internal medicine (PIM) resulted in better performances on subsequent clinical rotations and increased interest in internal medicine.
PARTICIPANTS
Fifty-four students have participated in the PIM to date, with control groups consisting of students who applied for it but were not selected (n = 36), students participating in a preceptorship in family medicine (n = 168), and the remaining students (n = 330).
DESIGN
Prospective cohort study.
SETTING
University medical center and community practices.
INTERVENTION
A 2-month, clinical preceptorship following the first year of medical school.
MEASUREMENTS AND MAIN RESULTS
The following outcomes were assessed: scores in the introduction to clinical medicine course; grades in the medical ethics course; scores from the internal medicine clerkship; and choosing a career in internal medicine. In their second year, PIM students scored higher in both semesters of the introduction to clinical medicine course (87% and 86% vs 84% and 84%, p’s < .01) and were more likely to receive honors in ethics (50% vs 29%, p < .01) than non-PIM students. During the internal medicine clerkship, PIM students’ scores were significantly higher on an objective structured clinical examination (79% vs 76%, p = .05), ambulatory clinical evaluations (80% vs 76%, p < .01), and overall clerkship scores (78% vs 75%, p = .03) but not on inpatient clinical evaluations or on the National Board of Medical Examiners Subject Examination. Preceptorship students were more likely to receive honors grades in the medicine clerkship (33% vs 10%, p < .01), and they were more likely to match into internal medicine residencies than control students (54% vs 27%, p < .01).
CONCLUSIONS
The PIM course is an intervention, early in students’ careers, which appears to benefit them academically and increase their interest in internal medicine as a career.
doi:10.1046/j.1525-1497.1999.00352.x
PMCID: PMC1496599  PMID: 10354253
medical students; clinical competence; curriculum
3.  Oral Versus Written Feedback in Medical Clinic 
OBJECTIVE
To determine whether residents perceived oral, face-to-face feedback about their continuity clinic performance as better than a similar, written version.
DESIGN
Single-blind, randomized controlled trial.
SETTING
Two university-based, internal medicine residency clinics.
PARTICIPANTS
All 68 internal medicine and combined program (medicine-pediatrics, medicine-psychiatry, medicine-neurology, and preliminary year) residents and their clinic preceptors.
MEASUREMENTS AND MAIN RESULTS
Residents at each program were separately randomized to oral or written feedback sessions with their clinic preceptors. The oral and written sessions followed similar, structured formats. Both groups were later sent questionnaires about aspects of the clinic. Sixty-five (96%) of the residents completed the questionnaire. Eight of the 19 questions dealt with aspects of feedback. A feedback scale was developed from the survey responses to those eight questions (α= .86). There were no significant differences in the responses to individual questions or in scale means (p >.20) between the two feedback groups. When each university was analyzed separately, one had a higher scale mean (3.10 vs 3.57, p = .047), but within each university, there were no differences between the oral and written feedback groups (p >.20).
CONCLUSIONS
No differences were observed between the oral and written feedback groups. In attempting to provide better feedback to their residents, medical educators may better apply their efforts to other aspects, such as the frequency of their feedback, rather than the form of its delivery.
doi:10.1046/j.1525-1497.1998.00049.x
PMCID: PMC1496929  PMID: 9541371
feedback; medical education; internal medicine; ambulatory care; residents

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