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The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use?

Sargeant, Joan, PhD; Lockyer, Jocelyn M., PhD; Mann, Karen, PhD; Armson, Heather, MD; Warren, Andrew, MSc, MD, FRCPC; Zetkulic, Marygrace, MD; Soklaridis, Sophie, PhD; Könings, Karen D., PhD; Ross, Kathryn, MSc; Silver, Ivan, MD, MEd, FRCPC; Holmboe, Eric, MD; Shearer, Cindy, PhD; Boudreau, Michelle, MA

doi: 10.1097/ACM.0000000000002131
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Purpose The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use.

Method From July 2014–October 2016, case study methodology was used to study R2C2 model use and the influence of context on use within and across five cases. Five residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesia) from three countries (Canada, the United States, and the Netherlands) were recruited. Data collection included audiotaped site assessment interviews, feedback sessions, and debriefing interviews with residents and supervisors, and completed learning change plans (LCPs). Content, thematic, template, and cross-case analysis were conducted.

Results An average of nine resident–supervisor dyads per site were recruited. The R2C2 feedback model, used with an LCP, was reported to be effective in engaging residents in a reflective, goal-oriented discussion about performance data, supporting coaching, and enabling collaborative development of a change plan. Use varied across cases, influenced by six general factors: supervisor characteristics, resident characteristics, qualities of the resident–supervisor relationship, assessment approaches, program culture and context, and supports provided by the authors.

Conclusions The R2C2 model was reported to be effective in fostering a productive, reflective feedback conversation focused on resident development and in facilitating collaborative development of a change plan. Factors contributing to successful use were identified.

J. Sargeant is professor, Continuing Professional Development Program and Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

J.M. Lockyer is professor, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

H. Armson is assistant dean, Continuing Professional Development, and associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.

A. Warren is associate professor, Department of Pediatrics, and associate dean, Postgraduate Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

M. Zetkulic is assistant professor, Seton Hall School of Medicine, Director of Medical Education, Department of Medicine, Hackensack University Hospital, Hackensack, New Jersey.

S. Soklaridis is assistant professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

K.D. Könings is associate professor, Department of Educational Development & Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

K. Ross is research associate, Department of Evaluation, Research and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania.

I. Silver is vice president of education, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

E. Holmboe is senior vice president of milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor of medicine, Yale University, New Haven, Connecticut, and adjunct professor, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

C. Shearer is evaluation specialist, Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.

M. Boudreau is evaluation specialist, Continuing Professional Development, Dalhousie University, Halifax, Nova Scotia, Canada.

Funding/Support: Funding for this study was provided by the National Board of Medical Examiners, Stemmler Fund, 2014–2016.

Other disclosures: None reported.

Ethical approval: Ethical approval was provided on July 18, 2014, from Dalhousie University, Health Sciences Research Ethics Board, Halifax, Nova Scotia (REB #2014-3301), and as required by each site.

Previous presentations: Sargeant J, Lockyer J, Mann K, et al. Testing the R2C2 feedback model in residency education: Does it foster interaction, reflection and shared planning for change? Oral presentation at: Canadian Conference on Medical Education (CCME) 2017—Rethinking Teaching and Learning; April 29–May 2, 2017; Winnipeg, Manitoba, Canada.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A522, http://links.lww.com/ACADMED/A523, and http://links.lww.com/ACADMED/A524.

Correspondence should be addressed to Joan Sargeant, Continuing Professional Development Program and Division of Medical Education, Dalhousie University, 5849 University Ave., Room C-106, PO Box 15000, Halifax, NS B3H 4H7 Canada; telephone: (902) 494-1995; e-mail: Joan.sargeant@dal.ca.

© 2018 by the Association of American Medical Colleges