American Society of Regional Anesthesia and Pain Medicine August 2018 - 18

among approximately 21 million hospitalizations of Medicare
beneficiaries, adjusted 30-day mortality rates were significantly
lower at 250 major teaching hospitals compared with 894 minor
teaching and 3,339 nonteaching hospitals (8.3% vs 9.2% and
9.5%, respectively). Significantly lower 30-day mortality was also
observed in major teaching versus nonteaching hospitals in 11 of
15 medical conditions and two of six surgical procedures evaluated.
In addition, sensitivity analysis revealed significantly lower 7-day
and 90-day mortality in teaching versus nonteaching hospitals.
The differences in mortality by teaching status may be related to
greater experience treating particular conditions or earlier adoption
of new technology. However, accounting for hospital volume did not
substantially explain the observed mortality differences.

Feedback is important for resident development, but nuances of
providing feedback to trainees with various personality traits or skill
levels may be challenging. In this single-center qualitative study,
18 preceptors participated in feedback simulations of resident-
patient interactions. Each preceptor watched four separate
recorded interactions of a resident (portrayed by a professional
actor) discussing goals of care with a patient. In each recording, the
resident possessed a unique trait: (1) highly performing resident,
(2) resident with insight gaps, (3) overly confident resident, and (4)
emotionally distressed resident. After observing the interactions,
the preceptor had 8-10 minutes to provide feedback to the resident
(actor), which was followed by an 8- to 10-minute debrief with a
study facilitator regarding the feedback.

Final thought: Admission to a major teaching hospital was
associated with lower overall 30-day mortality compared with
admissions to a nonteaching hospital; however, the study had
several confounding factors and must be interpreted with caution.

Analysis of recorded feedback sessions demonstrated that
preceptors adapted their feedback to the different scenarios but
identified unique challenges in each context. Unique approaches
to providing feedback could be considered, including coaching a
high-performing resident (eg, framing feedback as a conversation,
encouraging the resident to identify strengths and challenges),
directing a resident with insight gaps because self-assessment
is ineffective in achieving insight, mediating an overly confident
resident (eg, encouraging reflection on patient experience, eliciting
ideas for implementing teaching points from the resident), and
mentoring an emotionally distressed resident (eg, exploring source
of distress, asking permission to defer feedback, identifying support
for the resident, sharing own strategies).

ADAPTING FEEDBACK TO INDIVIDUAL RESIDENTS: AN
EXAMINATION OF PRECEPTOR CHALLENGES AND APPROACHES
des Ordons AR, Cheng A, Gaudet J, et al. J Grad Med Educ.
2018;10(2):168-175.

Final thought: Understanding the challenges educators encounter
and approaches taken to adapt feedback to individual trainees may
help faculty meet the challenges of competency-based medical
education.

The study findings were limited only to mortality; therefore,
other hospital quality metrics were excluded. Because the study
included only Medicare patients, results may not be generalizable
to nonelderly populations. In addition, it did not account for patient
preferences in end-of-life care. Variations in palliative care practice
across teaching and nonteaching hospitals may confound mortality
rates.

18

American Society of Regional Anesthesia and Pain Medicine
2018



Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2018

American Society of Regional Anesthesia and Pain Medicine August 2018 - 1
American Society of Regional Anesthesia and Pain Medicine August 2018 - 2
American Society of Regional Anesthesia and Pain Medicine August 2018 - 3
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American Society of Regional Anesthesia and Pain Medicine August 2018 - 18
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