R2C2 feedback and coaching resources

R2C2 Guide [PDF - 480 KB]

Annotated R2C2 and coaching skills demo: https://www.youtube.com/watch?v=8Zf0IsAVrlw

This video is an annotated demonstration of the R2C2 phases with particular emphasis on the coaching phase and coaching strategies.  It also demonstrates several important features of feedback and coaching; i.e., it incorporates both longitudinal coaching and in-the-moment coaching following a specific incident. It also demonstrates facilitation and coaching approaches to use in a situation which could be challenging, when the learner has not addressed a sensitive issue and needs guidance to do so.

We’re grateful to Sam Lai MD for contributing his acting skills, and Marygrace Zetkulic MD, for her acting and video editing and annotation contributions.   

Dr Sam Lai is Assistant Clinical Professor, Associate Program Director, Internal Medicine Residency Program, Hospitalist and Perioperative Medicine, Department of Medicine, University of California, Irvine Health.   Dr Marygrace Zetkulik is Program Director of Internal Medicine, Assistant Professor of Medicine Hackensack Meridian School of Medicine, Department of Medicine, Hackensack University Medical Center, New Jersey, and a member of the R2C2 research team. 

Tri-fold: R2C2 for feedback with groups [PDF-560KB]

Tri-fold: R2C2 for feedback with practicing physicians [PDF-560KB]

Tri-fold: R2C2 for residents’ formal feedback [PDF-581KB]

Below are links to 2 videos demonstrating the R2C2 model in a formal feedback and coaching discussion with a resident.  The first uses more competency-base language while the second is more generic.  A suggestion while watching the videos is to have the Resident Formal tri-fold in hand and try to identify each of the 4 phases and the phrases the supervisor uses, as well as the resident’s responses. 

Video 1 uses competency based language: https://youtu.be/_cSDQYjUEok

Video 2 uses generic language: https://youtu.be/-ljhCWYujks

Sample Action Plan [PDF - 396KB] 

Tri-fold: R2C2 for learners in the moment feedback [PDF-561KB]

REFERENCES:

·         Deiorio NM. Accessible Feedback and Coaching Techniques for Everyday Clinical Faculty. J Grad Med Educ: 2020 Feb: 12(1): 36-37.  https://www.jgme.org/doi/full/10.4300/JGME-D-19-00965.1

·         Lockyer J, Armson H, Könings KD, Lee-Krueger RCW, des Ordons AR, Ramani S, Trier J, Zetkulic MG, Sargeant J. In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context. J Grad Med Educ. 2020 Feb;12(1):27-35.  https://www.jgme.org/doi/full/10.4300/JGME-D-19-00508.1

VIDEOS: 

Below are links to 3 videos demonstrating the R2C2 model in informal “in-the-moment” feedback and coaching discussions:  Video 1 demonstrates a brief conversation with a clinical clerk at the beginning of a day to clarify goals and plan the day.  Video 2 demonstrates the feedback and coaching discussion with the same clerk at the end of that clinic using the 4 phases of the R2C2 model.  Video 3 demonstrates planning and a feedback/coaching discussion with a resident following a family meeting.

A suggestion while watching videos 2 and 3 it is to have the “In-the-moment” tri-fold in hand and try to identify each of the 4 phases and the phrases the supervisor uses, as well as the resident’s responses. 

https://youtu.be/13tDGRoHL1g - Introduction and planning with a clinical clerk (1.5 minutes)

https://youtu.be/MuEnhqjHOlQ - Feedback and coaching the clinical clerk following history taking  (7 minutes)

https://youtu.be/N0LFPfDk4HY - Planning for, and feedback and coaching with a resident following a family meeting (6 minutes, 22 seconds)

Tri-fold: R2C2 for nurses [PDF - 561KB]

REFERENCES: Developing and Testing R2C2

·         Arabsky S, Castro N, Murray M, Bisca I, Eva KW. The Influence of Relationship-Centered Coaching on Physician Perceptions of Peer Review in the Context of Mandated Regulatory Practices. Acad Med. 2020 Nov;95(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 59th Annual Research in Medical Education Presentations):S14-S19. doi: 10.1097/ACM.0000000000003642. PMID: 32769452.
https://pubmed.ncbi.nlm.nih.gov/32769452/

·         Armson, H., Lockyer, J.M., Zetkulic, M.G., Könings, K.D., & Sargeant, J. (2019). Identifying coaching skills to improve feedback use in postgraduate medical education. Medical Education, 53(5):477-493. doi: 10.1111/medu.13818 
https://onlinelibrary.wiley.com/doi/full/10.1111/medu.13818

·         Graham R, Beuthin R. Exploring the Effectiveness of Multisource Feedback and Coaching with Nurse Practitioners. Nurs Leadersh (Tor Ont). 2018;31(1):50-59.     https://www.longwoods.com/content/25472

·         Lockyer J, Armson H, Könings KD, Lee-Krueger RCW, des Ordons AR, Ramani S, Trier J, Zetkulic MG, Sargeant J. In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context. J Grad Med Educ. 2020 Feb;12(1):27-35.  https://www.jgme.org/doi/full/10.4300/JGME-D-19-00508.1

·         Lockyer, J., Armson, H.A., Könings, K.D., Zetkulic, M., Sargeant, J., (2019) Impact of Personalized Feedback: The Case of Coaching and Learning Plans, In M Henderson, R Ajjawi, D Boud, and E Molloy, The impact of feedback in higher education, Palgrave Macmillan     https://www.palgrave.com/gp/book/9783030251116

·        Pooley M, Pizzuti C, Daly M. Optimizing Multisource Feedback Implementation for Australasian Physicians. J Contin Educ Health Prof. 2019 Fall;39(4):228-235. doi: 10.1097/CEH.0000000000000267. PMID: 31567831.  https://pubmed.ncbi.nlm.nih.gov/31567831/

        Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., Driessen, E., MacLeod, T., Yen, W., Ross, K. & Power, M. (2015). Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2). Acad Med, 90(12), 1698-706. doi: 10.1097/ACM.0000000000000809.     https://insights.ovid.com/article/00001888-201512000-00034

·         Sargeant, J., Armson, H., Driessen, E., Holmboe, E., Könings, K., Lockyer, J., Lynn, L., Mann, K., Ross, K., Silver, I., Soklaridis, S., Warren, A., Zetkulic, M., Boudreau, M., Shearer, C. Evidence-informed facilitated feedback: the R2C2 feedback model.MedEdPORTAL. 2016;12:10387.    https://doi.org/10.15766/mep_2374-8265.10387

·         Sargeant, J., Mann, K., Manos, S., Epstein, I., & Warren, A., Shearer, C., & Boudreau M. (2017). R2C2 in Action: Testing an Evidence-Based Model to Facilitate Feedback and Coaching in Residency. J Grad Med Educ, 9(2), 165-170. doi: 10.4300/JGME-D-16-00398.1.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398131/

·         Sargeant, J., Lockyer, J.M., Mann, K., Armson, H., Warren, A., Zetkulic, M., Soklaridis, S., Könings, K.D., Ross, K., Silver, I., Holmboe, E., Shearer, C., & Boudreau M. (2018). The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? Acad Med, 93(7), 1055-1063. doi: 10.1097/ACM.0000000000002131.     https://insights.ovid.com/crossref?an=00001888-201807000-00030

·        Safavi AH, Papadakos J, Papadakos T, Quartey NK, Lawrie K, Klein E, Storer S, Croke J, Millar BA, Jang R, Bezjak A, Giuliani ME. Feedback Delivery in an Academic Cancer Centre: Reflections From an R2C2-based Microlearning Course. J Cancer Educ. 2021 Jun 24.doi: 10.1007/s13187-021-02028-9. Epub ahead of print. PMID: 34169464. https://pubmed.ncbi.nlm.nih.gov/34169464/ 

·         R2C2 resource website: https://medicine.dal.ca/departments/core-units/cpd/faculty-development/R2C2.html

         Forming, Storming, Norming, and Performing | Understanding the Stages of Team Formation | MindTools website:  https://www.mindtools.com/pages/article/newLDR_86.htm