Document Type


Publication Date



Background: Feedback is an educational responsibility of residents at most academic medical centers. Heretofore, our internal medicine residents have received little consistent instruction or training in providing feedback. Recently our institution has developed 3-hour workshops for training faculty to provide formative feedback using a good judgment' model. Building on work done at the Harvard Center for Medical Simulation and education literature, the 'good judgement' model stimulates self reflection in the learner to both identify and address behaviors that diverge from optimal clinical practice. This self reflection is achieved when the teacher observes gaps in the learner's practice, advocates for optimal practice and uses inquiry to understand the learner's frames (knowledge, assumptions, and feelings). Frames are believed to drive actions, and once obtained, these frames are then targeted by the teacher in order to transform the learners understanding and alter future behavior. Purpose: To develop and test a 'feedback using good judgment' model for training for internal medicine residents. Description: Hospitalist faculty attended a 3-hour workshop in providing formative feedback using a 'good judgment' model. These hospitalists then worked with workshop trainers to modify this workshop into a 90-minute training session specifically for internal medicine residents. The modified resident training session included a 45 minute didactic describing and illustrating the 'feedback with good judgment' model followed by 45 minutes of small group practice where residents role-played giving formative feedback to learners presenting with errors in judgment. 'Batting practice', a technique adapted from Motivational Interviewing training, was used to give residents practice in developing the kind of in-the-moment feedback required in the quick-paced clinical environment. Residents were surveyed at the conclusion of this session. 46 of our 72 internal medicine residents attended this session. 42/46 (91 %) completed an anonymous voluntary survey. Of respondents, 19/41 (46%) were female and 18/42 (43%) considered themselves ethnic minority. Level of training was PGY1 18/42 (43%), PGY2 11/42 (26%), and PGY3 13/42 (31%). Respondents indicated that they regularly provided feedback to medical students (39/42, 93%), PGY1 residents (26/42, 62%), upper level residents (4/42, 9%), and attendings (10/42, 24%). Using a 5-point Likert scale, attendees' perceived confidence in providing feedback rose after the training session (means of 3.19 to 4.07; difference = 0.88, p< 0.01, two-tailed paired t-test). Conclusions: Residents report giving feedback to students on a regular basis and to faculty and other residents to some degree. A 90-minute training-session in 'feedback with good judgment' can increase internal medicine resident confidence in providing feedback to learners.'


Poster presentation at Alliance for Academic Internal Medicine: Academic Internal Medicine Week 2013, 10/04/2013, New Orleans, LA.