Creating Middle Stage: Finding a New Space for Reflection within a Residency Program

While communication is essential to effective clinical outcomes, training programs that employ synchronous feedback systems are expensive and time consuming. Using a secure web blog as an asynchronous alternative for enhancing communication skills, we created a unique middle stage learning opportunity within a residency training program. Each resident was recorded interacting with a patient and that digital record was posted to a secure blog. By the end of year three, the residents (N = 6) interacted with 20 patients and wrote a blog post discussing each interaction. The other residents watched these interactions and responded to their peers' digitized interactions in the form of a blog post (N = 95). Transcripts were created and analyzed using the constant comparative method and yielded five categories of resident message types. They were: Narrative of the visit, visit issues, communication strategies, social support, and reflections on the experience and provided a unique opportunity to examine interaction among the residents.