A 72-year-old woman with a history of poorly controlled diabetes, coronary artery disease, and hypertension presents to the emergency department complaining of nausea and vomiting. As an emergency department resident, you elicit the history that the patient felt well until 24 hours ago, when she developed anorexia followed rapidly by bilious emesis. She describes mild upper abdominal discomfort but is unable to further localize the pain and reports no abnormal bowel movements, gastrointestinal bleeding, or chest pain.The patient is febrile (39°C) and appears uncomfortable. Her lungs are clear and cardiac examination reveals only a fourth heart sound. There is moderate epigastric tenderness and guarding throughout the abdomen but no rigidity. Pelvic and rectal examination results are unremarkable. Electrocardiography shows no changes suggestive of ischemia. Laboratory testing shows a leukocytosis of 17 500 ×10 3 /µL, serum transaminase levels twice the upper limit of normal, and a total bilirubin level of 3.2 mg/dL (54.7 µmol/L). In considering the differential diagnosis for the patient's presenting complaint and laboratory results, you wonder whether the suspicion of acute cholecystitis is high enough to warrant further testing. Why Is This Question Important?Acute cholecystitis accounts for 3% to 9% of hospital admissions for acute abdominal pain. [1][2][3][4] The majority of patients presenting with upper abdominal complaints are subsequently found to have a relatively benign cause of pain (eg, dys-Author Affiliations are listed at the end of this article.

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Feedback is considered an important means of improving learner performance, as evidenced by the number of articles outlining recommendations for feedback approaches. The literature on feedback for learners in medical education is broad, fairly recent, and generally describes new or altered curricular approaches that involve feedback for learners. High-quality, evidence-based recommendations for feedback are lacking. In addition to highlighting calls to reassess the concepts and complex nature of feedback interactions, the authors identify several areas that require further investigation.