Table 4 Qualitative analysis of feedback on critical incident questionnaire

Factors that improved learning

 Feedback on performance

32

• “While doing the intervention—it was helpful to engage in the encounter and then get real time feedback on tips to use while speaking with parents. They were useful, practical tips.”

• “I was most engaged while getting active feedback during the practice scenarios. I felt this was helpful to point ways to improve in connecting with the family to both address their concerns and make sure they understand my recommendations.”

 Group session observing peers interacting with SPs

24

• “The practice SP intervention sessions were extremely valuable, especially with real time feedback from the SPs regarding communication skills and specific key words.”

• “I was most engaged while other [participants] were presenting in front of the group and then we discussed what they did well and other suggestions for connecting better with the patient and their family in the future.”

• “The active discussion of standardized patient encounters that occurred during the teaching time—we were able to pause, re-direct the encounters and then re-try after discussion, which I found very helpful.”

 Case discussion

15

• “When we were going through scenarios as a group and brainstorming better ways to address common issues that come up.”

• “I felt most engaged during the facilitated debrief of the standardized patient sessions.”

 Interactively working with SPs

12

• “Definitely during the counseling of the SPs, putting theory into practice.”

• “I felt engaged during each case encounter.”

 Communication Skills: General Principles

10

• “Discussion of techniques in communicating challenging information. Focus on specific language.”

• “Specific strategies for approaching patients and family who were more difficult to convince of the utility of going through a particular therapeutic plan.”

 Communication Skills: Specific to Referral

7

• “Discussion of when and how to refer patients, specifics of dealing with difficult patients who desire a referral in spite of lack of indication”

• “Specific information to give a patient when referring them to a specialist”

Factors that hindered learning

 Structure of session

15

• “The post-encounter sessions where we had to then go in to two additional sessions with standardized patients. I felt that it was repetitive. To better assess what was learned, I would have preferred a time-delayed post-encounter perhaps a few days after review of the intervention.”

• “It was really frustrating to have so much wasted down time during the morning.”

• “Filling out forms”

 Learner passivity

8

• “When we were going through the PowerPoint, especially since it was a little more difficult to see.”

• “The lecture conveyed very interesting information, but the presentation portions of lectures are always the hardest to pay attention to.”