Constructing a Shared Mental Model for Feedback Conversations: Faculty Workshop Using Video Vignettes Developed by Residents

INTRODUCTION

Providing feedback is a fundamental principle in medical education; however, as educators, our community lacks the necessary skills to give meaningful, impactful feedback to those under our supervision. By improving our feedback-giving skills, we provide concrete ways for trainees to optimize their performance, ultimately leading to better patient care.

METHODS

In this faculty development workshop, faculty groups used six feedback video vignettes scripted, enacted, and produced by residents to arrive at a shared mental model of feedback. During workshop development, we used qualitative analysis for faculty narratives combined with the findings from a focused literature review to define dimensions of feedback.

RESULTS

Twenty-three faculty (physical medicine and rehabilitation and neurology) participated in seven small-group workshops. Analysis of group discussion notes yielded 343 codes that were collapsed into 25 coding categories. After incorporating the results of a focused literature review, we identified 48 items grouped into 10 dimensions of feedback. Online session evaluation indicated that faculty members liked the workshop's format and thought they were better at providing feedback to residents as a result of the workshop.

DISCUSSION

Small faculty groups were able to develop a shared mental model of dimensions of feedback that was also grounded in medical education literature. The theme of specificity of feedback was prominent and echoed recent medical education research findings. Defining performance expectations for feedback providers in the form of a practical and psychometrically sound rubric can enhance reliable scoring of feedback performance assessments and should be the next step in our work.

Up-regulation of heme oxygenase provides vascular protection in an animal model of diabetes through its antioxidant and antiapoptotic effects

Heme oxygenase (HO) plays a critical role in the regulation of cellular oxidative stress. The effects of the reactive oxygen species scavenger ebselen and the HO inducers cobalt protoporphyrin and stannous chloride (SnCl(2)) on HO protein levels and activity, indices of oxidative stress, and the progression of diabetes were examined in the Zucker rat model of type 2 diabetes. The onset of diabetes coincided with an increase in HO-1 protein levels and a paradoxical decrease in HO activity, which was restored by administration of ebselen. Up-regulation of HO-1 expressed in the early development of diabetes produced a decrease in oxidative/nitrosative stress as manifested by decreased levels of 3-nitrotyrosine, superoxide, and cellular heme content. This was accompanied by a decrease in endothelial cell sloughing and reduced blood pressure. Increased HO activity was also associated with a significant increase in the antiapoptotic signaling molecules Bcl-xl and phosphorylation of p38-mitogen-activated protein kinase but no significant increases in Bcl-2 or BAD proteins. In conclusion, 3-nitrotyrosine, cellular heme, and superoxide, promoters of vascular damage, are reduced by HO-1 induction, thereby preserving vascular integrity and protecting cardiac function involving an increase in antiapoptotic proteins.