Table 2 Representative Quotations and Associated CFIR Domains for Key Themes
Logic Model Domain | Theme | Representative Quotations | Associated CFIR Domains |
|---|---|---|---|
Context | Gap in communication education | - Learning communication skills was built into a lot of the rotations that we had… Just seeing physicians who are higher than me modeling family meetings… was… how I was able to learn to do it. (P3 – Coach Neurology) - It’s typically an unstructured hidden curriculum. (P12 – Medical Education Leader, Programmatic Sponsor Surgery) | Intervention Characteristics |
Patient-centeredness | - Patients are more satisfied… There’s an alliance that is formed when there is good communication. I think that not only are patients happier, but they get better care, and they are healthier, probably. (P4 – Coach Neurology) - There is a lot of therapeutic benefit to just having good rapport and communication with people. (P34 – Resident Surgery) | Intervention Characteristics | |
Inputs and Outputs | Investment in program | - You’ve got to have some… faculty development so that the coaches don’t feel like the blind leading the blind. (P2 – Coach Neurology) Funding is extremely important. That comes from buy-in from the hospital, or programs, or chairs, because what makes the coaching program disseminate and sustain itself is a robust reimbursement structure - (P11 – Medical Education Leader Surgery) | Intervention Characteristics, Inner setting, Characteristics of Individuals, Process |
Perceived program value | • If it’s tailored to what [the residents] feel is important, then there will… be more buy in and engagement, and that could differ by what year the person is, maybe what specialty they’re in. (P26 – Resident Neurology) • There’s a huge value in the relationship building between trainees and faculty, which, I think is confidence building for trainees. It helps trainees… feel more established within the program in general and that they have a safety net in some ways. (P5 – Coach Surgery) | Intervention Characteristics, Inner Setting | |
Outcomes | Learning or action-focused outcomes | • Some of the material that we go through, that’s part of the coaching side of the material, is helpful in my own life, in my own clinic… I become a better communicator because of that. (P1 – Coach Neurology) • I think a lot of things I kind of just do… We’re very busy as residents, but I think it makes me… in line with self-reflection… it makes me more cognizant of the way I’m doing things, the way I’m phrasing things. (P34 – Resident Surgery) | Characteristics of Individuals, Process |
Cultural or patient-related outcomes | • It helps me provide better patient care if I’m better able to communicate with my patients. Obviously, if I am able to communicate more effectively with other teams, that also procures better care for the patients on my team. (P33 – Resident Surgery) • It changed the way that we approach feedback in the department, so that our learners are setting their own goals, they’re asking, they’re seeking feedback and it changed our culture from being a performance culture to being much more of a growth mindset. That has extended beyond our residents. I think part of it is just embracing that it can really revolutionize the feedback culture. (P19 – Programmatic Sponsor Pediatrics) | Inner Setting and Outer Setting | |
Evaluation | Defining success | • The most successful outcome is improving patients’ satisfaction scores… that’s the ultimate outcome. (P11 – Medical Education Leader Surgery) • I think, for myself, if seven years from now, by the time I’m graduating, I sense a change in the surgical culture, where people are notably nurturing each other, helping each other thrive, respectful and happy to be at work together, and are saying things where you can clearly see they’re inspired by each other, I think that would be a success. (P35 – Resident Surgery) | Process |
Challenges with evaluation | • It’s really difficult to get great outcomes data for a program like this in the sense of are our residents better communicators today than they were a year ago? That’s difficult to say… But I do know that the residents are happy with the program and on the program side, we certainly get a lot of good written feedback from the communication coaches that give a lot of insight. (P14 – Medical Education Leader Neurology) • …one of the holy grails is patient level metrics… but those are also very noisy metrics that have so many different things competing for their input that the signal to noise ratio could be really hard to separate… (P10 – Medical Education Leader Neurology) | Process |