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create an open two-way conversation and allows the teacher to assess the resident’s
mindset and insight [ 33 ].
Feedback should be based on direct observations in order to provide the most
realistic assessment for the learner. This allows the educator to discuss specific
events that were appropriate or needed improvement. When feedback focuses on
generalities, it leaves the learner with an incomplete assessment and with little
direction for improvement [ 32 , 33 ]. Furthermore, the quantity of feedback given
should be limited to one or two topics in order to not overwhelm the learner in the
context of any given interaction [ 32 ]. Feedback is most effective when it occurs in a
respectful environment, is based on direct observation rather than hearsay, is non-
judgmental, is specific rather than general, is focused on limited elements rather
than a wide range of topics, is oriented to behavior and skills rather than personality
traits, is goal or objective based, is accomplished in the context of dialog, and
includes suggestions for improvement [ 33 ].
Each feedback session concludes with the development of goals for future expe-
riences. Goals for improvement should include strategies and input from both the
educator and the learner. Strategies might include further reading of the literature,
working in the skills lab, or new approaches to procedures. At the conclusion, the
educator and learner agree upon the goals, and then the learner reviews his or her
understanding of the feedback [ 33 ].
Having reviewed the critical nature of feedback as an essential skill in all learn-
ing settings and environments, we will now turn to reviewing specific strategies
residents can use and develop as part of their learning and teaching repertoire to
enhance their effectiveness. In the following sections, we will identify several spe-
cific teaching models and strategies useful in framing and developing educational
competency and the journey toward independent practice, both clinically and
pedagogically.
Teaching Models
There are many models in the current medical education literature proposed to help
faculty teach residents and to assess a resident’s level of competency. Although
many residency programs offer a “Residents as Teachers” course to develop senior
residents’ leadership skill acquisition, there is relatively little focused scholarship in
the current medical education literature describing specific techniques for senior
residents to employ in teaching junior learners. In the following section, we will
describe several models that may be adapted in training residents as teachers.
Dreyfus Model and Learner-Focused Teaching
The Dreyfus model of skill acquisition lays a framework for skill acquisition by
describing developmental stages beginning with novice and progressing through
advanced beginner, competent, proficient, expert, and master [ 37 ]. The progression
J. Feimster et al.