Jennifer Spicer, MD, MPH Profile picture
Apr 20, 2021 16 tweets 10 min read Read on X
1/ This week the #MedEdTwagTeam is bringing you a final #TweetorialTuesday summarizing the #feedback threads from @GStetsonMD & @JenniferSpicer4 over last 10 weeks. Image
2/ If you missed any of our threads, you can go to the @MedEdTwagTeam handle and follow so you don’t miss out!

Check out our pinned tweet, which has "Moments" for each of our #tweetorial series. Image
3/ Week 1 provided an overview, and Week 2 emphasized the importance of relationships & culture as the foundation of effective feedback.

@GStetsonMD emphasized these 2 articles:
1⃣The Educational Alliance: pubmed.ncbi.nlm.nih.gov/25406607/
2⃣Feedback as Coaching: pubmed.ncbi.nlm.nih.gov/30907439/ Image
4/ We also emphasized the importance of both modeling & promoting a growth mindset rather than a fixed mindset.

Here's a short article in @MedEd_Journal describing applications of Carol Dweck's growth mindset theory in #MedEd

…ary-wiley-com.proxy.library.emory.edu/doi/10.1111/me… Image
5/ In Week 3, we discussed some common components of effective feedback.

My discussion of appropriate "timing" seemed to resonate with learners and reminded us that sometimes learners are not in an emotional space for feedback (e.g., after a code or after an overnight call). Image
6/ In Week 4, @GStetsonMD described methods for feedback and provided us with the ART model:

A: Ask learners for their impression.
R: Reflect on what they said by paraphrasing it
T: Tell them your feedback focusing on their impressions.
See his thread for specific examples! Image
7/ In Week 5 & 6 we discussed formative & summative feedback.

During week's 5 formative feedback thread, we emphasized the coaching model. Trust is the key and allows daily feedback.

Daily feedback may sound like a lot - but remember, it's short, quick, & specific. Image
8/ Then, in Week 6, I discussed summative feedback, focused on the dreaded end-of-rotation feedback discussion.

But remember, it you have a learner-centered conversation anchored in your learner's previously identified goals, this can be a really impactful conversation! Image
9/ In Week 7, I discussed written feedback.

Be aware of our tendency to use "coded language" pubmed.ncbi.nlm.nih.gov/25693989/
Evaluate the narrative for bias/stereotypes. Resources:
*⃣handout @ucsfmed: meded.ucsf.edu/sites/meded.uc…

*⃣website to check for gender bias: slowe.github.io/genderbias/ Image
10/ In Week 8, @GStetsonMD emphasized avoiding the term "struggling learner" when we have learners who aren't meeting expectations.

There are MANY reasons this may happen. It's our job to identify the BEHAVIOR, discuss it openly (& bidirectionally) with our learners, & HELP them Image
11/ Here is an example he provided of how to have a conversation after identifying the behavior, cause, & frequency.

This is the "Tell" portion of an ART feedback conversation:
*⃣Name the behavior
*⃣Explain the impact
*⃣Ask the learner's reflections
*⃣Co-create goals Image
12/ In Week 9, I tackled the difficult problem of soliciting feedback, especially when hierarchy exists.

To get better feedback, consider asking peers & learners.

When soliciting feedback from learners, first ask for feedback on SPECIFIC areas, then GENERAL thoughts. Image
13/ In Week 10, @GStetsonMD closed with a discussion of how to receive feedback gracefully by highlighting 5 key strategies for cultivating this extremely important skill. Image
14/ This figure from Week 10 emphasizes how hearing feedback can help us identify blindspots.

Our intentions are not always represented by our actions or their impact.

Remembering this can help us take feedback gracefully and consider how to realign our intentions & actions. Image
15/ Thank you for joining the @MedEdTwagTeam on this feedback journey.

Next week, @GStetsonMD will start sharing threads on asking fair questions, then we will delve into a series on clinical teaching tips!

Let us know if there are specific topics that you want us to cover! Image

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More from @JenniferSpicer4

Mar 17, 2023
Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

@gradydoctorImage
Do you want a 4-step process for questions to ask when you get a page next year when you’re alone on nightfloat or ICU call?

Check out this framework! Image
And now, do you wanna remember who the heck to order DEXA scans for in clinic?

Thankfully Miko De Bruyn comes to the rescue. Image
Read 16 tweets
Mar 7, 2023
1/ You're seeing a new consult with your team, and you want to teach the primary team too.

But WHEN is the best time to teach them?

On the phone?
At the bedside?
In their team room?

And in the morning?
Or maybe the afternoon?

This week: Image
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.



But when should we teach them?

Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.

With one caveat.

Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.

But let's explore some general principles to consider.
Read 15 tweets
Feb 21, 2023
1/ You're finishing your last consult of the day.

It's late.
And it's been a long day.

You intended to find the primary team to teach them, but you have a million other things on your "to do" list.

Here are 8 reasons why you should still find time to teach the primary team. Image
2/ Reason #1: They want to learn

The primary team called with a question.
They are invested in the answer.

It's all about finding out what they want to know and targeting your teaching accordingly.
3/ Reason #2: It empowers them

Often the primary team has an idea of what to do but wants reinforcement that their plan is correct.

Teach them general rules that they can re-use. Image
Read 12 tweets
Jan 31, 2023
1/ Your team just saw a patient with syphilis, and you're ready to teach, but:

Resident #1: on week 2 of their rotation
👉 Has already seen 2 patients w/ syphilis

Resident #2: started today
👉 Hasn't seen a single patient with syphilis

What should you do now? Image
2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons. Image
3/ As @VarunPhadke2 previously pointed out, all learners on the team are usually not present all day, every day for the entire time we are on clinical services.

Image
Read 16 tweets
Jan 24, 2023
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.

Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow

How can you possibly provide valuable teaching to all of them?

This week: Multi-level teaching Image
2/ Teaching multi-level learners is hard.

Their range in baseline knowledge means a single teaching point is often not effective for everyone.

So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.

This is one 🗝️ for effective multi-level teaching.

Know what materials is RELEVANT and INTERESTING for each learner level.

Read 14 tweets
Jan 10, 2023
1/ *Re-consult 📞*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🤦 I feel you... We'll see the patient again. Image
2/ You wonder...

💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?
3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

Read 15 tweets

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