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Building an implementation framework for directly observed feedback by attending physicians.

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Directly observed feedback in medical education is acceptable to most residents and hospitalists. Key concerns include observer relationships and learning environment impact, emphasizing the need for psychological safety.

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Area of Science:

  • Medical Education
  • Healthcare Professional Development
  • Competency-Based Education

Background:

  • Effective formative feedback is crucial for resident training in competency-based medical education.
  • Current feedback curricula often lack observation of actual verbal feedback delivery.
  • Directly observed feedback is a novel approach with limited research on attitudes.

Purpose of the Study:

  • To explore attitudes towards directly observed feedback among Internal Medicine residents and hospitalists.
  • To identify concerns and suggestions regarding the implementation of observed feedback.

Main Methods:

  • Two surveys were developed for Internal Medicine residents and hospitalists at the University of Washington in 2023.
  • Surveys utilized quantitative (Likert scale) and qualitative (free text) analyses.
  • Study design incorporated principles of social cognitive theory.

Main Results:

  • Response rates were 71% for residents and 57% for hospitalists.
  • A majority reported comfort with observed feedback (81% residents, 64% hospitalists).
  • Concerns centered on observer relationships, learning environment, and feedback quality; suggestions focused on boundaries, agency, and integrity.

Conclusions:

  • Attitudes towards observed feedback are influenced by social monitoring and the need for psychological safety.
  • Implementing observed feedback requires careful consideration of relational dynamics and learner well-being.
  • Psychological safety is fundamental for successful observed feedback programs in medical training.