Transitioning to virtual academic detailing amid COVID-19: A case study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) public health protocols required medical educators to rapidly move curricula online. This included academic detailing (AD), a form of one-to-one or small group educational outreach for primary care providers (PCPs). OBJECTIVES: This study aimed to contribute to the sparse evidence base exploring virtual AD by exploring strengths, challenges, and best practices. METHODS: This case study drew on 3 methods: (1) observations of AD visits (n = 5 sessions), (2) group (n = 6 detailers) and one-on-one interviews (n = 5 PCPs, n = 3 detailing staff), and (3) document analysis of curriculum and policy documents (n = 10 documents). RESULTS: Our analysis identified several strengths of virtual detailing: (1) inherent benefits of virtual programming, (2) pre-existing strengths in program leadership, (3) global move toward telehealth amid COVID, (4) pre-existing detailing relationships, and (5) pre-existing roles and attributes of pharmacists. Several challenges were also identified: (1) virtual presence in group visits, (2) establishing consistency across modalities, and (3) technological issues. CONCLUSION: Virtual detailing has posed unique challenges and opportunities for innovation. Our study supports a blended model moving forward-one that balances strengths and challenges of virtual and in-person delivery and considers logistics, efficiencies, environmental impacts, and unique participant needs.

"Head of the Class": equity discourses related to department head appointments at one Canadian medical school.

Purpose: Equitable appointments of departmental leaders in medical schools have lagged behind other Equity, Diversity, and Inclusion (EDI) advancements. The purpose of this research was to 1) analyze how policy documents communicate changing ideas of EDI, employment equity, and departmental leadership; and 2) investigate department heads' (DH) perspectives on EDI policies and practices. Methods: We conducted a critical discourse analysis to examine underlying assumptions shaping EDI and departmental leadership in one Canadian medical school. We created and analyzed a textual archive of EDI documents (n = 17, 107 pages) and in-depth interviews with past (n = 6) and current (n = 12) DH (830 minutes; 177 pages). Results: Documents framed EDI as: a legal requirement; an aspiration; and historical reparation. In interviews, participants framed EDI as: affirmative action; relationships; numerical representation; and relinquishing privilege. We noted inconsistent definitions of equity-deserving groups. Conclusions: Change is slowly happening, with emerging awareness of white privilege, allyship, co-conspiracy, and the minority tax. However, there is more urgent work to be done. This work requires an intersectional lens. Centering the voices, and taking cues from equity-deserving leaders and scholars will help ensure that EDI pathways, such as those used to cultivate department leaders, are more inclusive, effective, and aligned with intentions.

Objectif: La nomination des directeurs de département dans les facultés de médecine accuse un retard en matière d'équité, de diversité et d'inclusion (EDI) en comparaison avec d'autres avancées. L'objectif de ce travail était 1) d'analyser dans quelle mesure les documents de politique reflètent l'évolution des idées liées à l'EDI, à l'équité en matière d'emploi et au leadership départemental; et 2) de sonder le point de vue des directeurs de département (DD) sur les politiques et les pratiques en matière d'EDI. Méthodes: Empruntant le cadre d'une analyse critique du discours, nous avons examiné les conceptions sous-jacentes qui façonnent l'EDI et le leadership des DD dans une faculté de médecine canadienne. Nous avons créé et analysé un corpus de documents relatifs à l'EDI (n=17, 107 pages) et d'entrevues approfondies avec des directeurs de département anciens (n=6) et actuels (n=12) (830 minutes; 177 pages). Résultats: Les documents décrivent l'EDI comme une obligation légale, une aspiration et une réparation historique. Lors des entretiens, pour définir l'EDI, les participants ont évoqué l'action positive, les relations, la représentation numérique et l'abandon de privilèges. Nous avons noté des incohérences quant à la définition de « groupe en quête d'équité ¼. Conclusions: Le changement s'opère lentement, avec une prise de conscience des notions de privilège blanc, d'alliance, de complicité et de taxe pour les minorités ¼. Cependant, il y a un travail plus urgent à accomplir. Ce travail nécessite une perspective intersectionnelle. Le fait d'écouter les leaders et les universitaires en quête d'équité et de leur accorder une place centrale fera en sorte que les voies de l'EDI, comme celles empruntées pour cultiver le leadership dans les départements, soient plus inclusives, plus efficaces et plus en adéquation avec les objectifs.

Application of the R2C2 Model to In-the-Moment Feedback and Coaching.

PURPOSE: The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use. METHOD: A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor-learner dyads. Data were collected during feedback sessions and follow-up interviews between March 2021 and July 2022. The research team familiarized themselves with the data, used a coding template to document examples of the model's application, reviewed the initial framework and revised the coding template, indexed and summarized the data, created a summary document, examined the transcripts for alignment with each model phase, and identified illustrative quotations and overarching themes. RESULTS: Fifteen dyads were recruited from 8 disciplines (11 preceptors were paired with a single resident [n = 9] or a single medical student [n = 2]; 2 preceptors each had 2 residents). All dyads were able to apply the R2C2 phases of building relationships, exploring reactions and reflections, and confirming content. Many struggled with the coaching components, specifically in creating an action plan and follow-up arrangements. Preceptor skill in applying the model, time available for feedback conversations, and the nature of the relationship impacted how the model was applied. CONCLUSIONS: The R2C2 model can be adapted to contexts where in-the-moment feedback conversations occur shortly after a clinical encounter. Experiential learning approaches applying the R2C2 model are critical. Skillful application of the model requires that learners and preceptors go beyond confirming an area of change and deliberately engage in coaching and cocreating an action plan.