Background: Following the absorption of residents from a closing institution, our internal medicine residency became one of the largest in the country (~250 residents). Residents rotate every two weeks and attendings rotate weekly, with intentionally staggered start days to promote patient safety. This structure, however, leads to discontinuity in observation and feedback, often resulting in residents working with up to three attendings per block. This fragmentation compounds existing challenges in learner assessment. Traditional evaluation processes, primarily the semiannual Clinical Competency Committee (CCC) review, are effective at identifying learners with prominent deficiencies but risk missing residents with more subtle, below-expectation performance. Additionally, new attendings report limited experience in delivering high-quality, actionable feedback. These challenges underscore the need for a more proactive, structured system of real-time performance monitoring and faculty support.
Purpose: To implement a biweekly Educational Feedback Huddle with the goal of:1. Improving early identification of residents with performance gaps2. Supporting attendings in delivering structured, competency-based feedback3. Enhancing communication with the CCC for timely intervention and continuity
Description: Launched in October 2024, each huddle includes the inpatient faculty, an associate program director (APD), and the hospital medicine education coordinator. Meetings occur in person or via Zoom and use the ACGME core competencies to guide discussion of all residents on the wards. The huddle helps faculty pinpoint which competencies a resident is struggling with, often with greater granularity and specificity than formal written evaluations.From October 2024 to November 2025, the huddle identified 8 residents with significant performance gaps (defined as deficits in 2 or more core competencies) and 19 residents performing below expectations in a single competency. All identified residents received individualized remediation plans and faculty support, with progress monitored by the CCC and advisors. The APD also provided targeted feedback points to assist attendings in holding effective feedback conversations. Summaries and follow-ups were shared with the CCC to ensure alignment with existing evaluation processes.Preliminary faculty feedback indicates increased confidence in delivering timely, competency-based assessments. Attendings appreciate the supportive environment, noting that it allows them to raise concerns they might otherwise soften or omit in written evaluations. They also report that the huddle is practical within their workflow and an efficient way to consolidate observations and plan next steps.
Conclusions: A biweekly Educational Feedback Huddle offers a reliable, real-time mechanism for detecting and addressing performance concerns in a large, complex residency program. It improves continuity, enhances educator coordination, and strengthens the CCC’s ability to initiate proactive remediation. Over 14 months, the huddle improved early identification, feedback quality, and remediation effectiveness, providing a scalable model for similarly structured programs. This approach is especially well-suited to programs in which teaching faculty are primarily hospitalists, as the huddle structure aligns naturally with hospitalist workflows and team transitions.