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Acad Med. 2015 Dec;90(12):1698-706. doi: 10.1097/ACM.0000000000000809.

Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2).

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J. Sargeant is professor and head, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. J. Lockyer is professor, Department of Community Health Sciences, and senior associate dean, Education, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. K. Mann is professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, and honorary professor and chair, Medical Education, Manchester Medical School, University of Manchester, Manchester, United Kingdom. E. Holmboe is senior vice president, 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. I. Silver is vice president, Education, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. H. Armson is assistant dean, Continuing Professional Development, and associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. E. Driessen is associate professor, Department of Educational Research and Development, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. T. MacLeod is research associate, Continuing Professional Development, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. W. Yen is research associate, Research and Evaluation Department, College of Physicians and Surgeons of Ontario, Toronto, Ontario, Canada. K. Ross is research associate, Department of Evaluation, Research and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. M. Power is manager, Nova Scotia Physician Achievement Review Program, College of Physicians and Surgeons of Nova Scotia



To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback.


To develop the feedback model (2011-2013), the authors drew on earlier research which highlights not only the factors that influence giving, receiving, accepting, and using feedback but also the theoretical perspectives which enable the understanding of these influences. The authors undertook an iterative, multistage, qualitative study guided by two recognized research frameworks: the UK Medical Research Council guidelines for studying complex interventions and realist evaluation. Using these frameworks, they conducted the research in four stages: (1) modeling, (2) facilitator preparation, (3) model feasibility testing, and (4) model refinement. They analyzed data, using content and thematic analysis, and used the findings from each stage to inform the subsequent stage.


Findings support the facilitated feedback model, its four phases-build relationship, explore reactions, explore content, coach for performance change (R2C2)-and the theoretical perspectives informing them. The findings contribute to understanding elements that enhance recipients' engagement with, acceptance of, and productive use of feedback. Facilitators reported that the model made sense and the phases generally flowed logically. Recipients reported that the feedback process was helpful and that they appreciated the reflection stimulated by the model and the coaching.


The theory- and evidence-based reflective R2C2 Facilitated Feedback Model appears stable and helpful for physicians in facilitating their reflection on and use of formal performance assessment feedback.

[Indexed for MEDLINE]

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