Feedback, Part 1Learning Skills and Techniques to Provide Meaningful Feedback

Institute for Excellence in EducationSummer Teaching Camp7/25/13Barry Solomon, MD, MPH

Thank you

Small Group Leaders• Meredith Atkinson• Joe Cofrancesco • Jules Jung• Rachel Levine• Leah Wolfe• Janet Serwint

“Fishbowl” Participants• Radu Dudas• Kristopher Kast• Kyle Mahoney• Tyler Mains• Brent Pottenger• Sarah Sunshine

Disclosure

The speaker and group facilitators have no financial relationship with any commercial interest.

Objectives

1. To appreciate the importance of giving meaningful feedback to learners.

2. To understand potential barriers and benefits to giving feedback.

3. To learn techniques and practice giving and receiving feedback (essential elements and Ask-Tell-Ask approach)

Session Timeline

• 8:30-8:50 - Feedback Overview• 8:50-9:05 - “Fishbowl” Exercise

– Student Voices• 9:10-9:45 – Feedback Practice • 9:50-10:00 – Large Group Wrap Up

Rationale for Giving Feedback

Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or, not at all.

Jack Ende - Feedback in Clinical Medical Education. JAMA 1983;250:777-781.

Good behavior is not reinforced

Mistakes goUncorrectedLearner will make

assumptions

Barriers

• Time commitment• Failure to obtain first hand data and specific

examples• Lack of perceived value• Previous negative experiences • Unclear performance expectations• Effects on teacher-learner relationship• Lack of training

Giving Back

• To the learner– Provides opportunity for growth– Helps develop insight into own behavior– Allows learner to reach self-defined goals

• To the teacher– Provides personal fulfillment– Demonstrates interest and caring

• To the profession– Responsibility to our patients and colleagues– Ensures the development of competent physicians

Essential Elements of Feedback

• Well timed and expected• Teacher and learner working together with

common goals• Based on first hand data• Regulated in quantity • Phrased in descriptive language, based on

specific observed behaviors

Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:777-781.

The Feedback Sandwich

Praise

Criticism

Praise

The New Feedback Sandwich

Ask

Tell

Ask

Ask

• Ask learner to assess own performance first– Phrase question to encourage meaningful reflection

• What went well?• What could have gone better?• What were your goals?

– Make sure to allow adequate time for the answer

• Begins a conversation• Assesses learner’s level of insight• Promotes self-assessment and reflective practice

Tell• React to the learner’s observation

– Feedback on self-assessment• Tell what you observed: use specific behaviors

without judgment (positive and constructive)• Instead of…“It’s annoying when you are late.”• Try…“I noticed you have been arriving late to rounds.”• Instead of… “You need to speak up, you’re too shy.”• Try… “When I asked for your input on patient

management, you didn’t say anything.”

Ask (again)

• Ask about learner’s understanding and strategies for improvement– What could you do differently?

– Again, give enough time– Give own suggestions– Consider replaying parts of the encounter: “show me”

• Close by committing to monitor improvement together

Small Group Practice Session

• Brief review of two tools– Feedback Checklist & Stepwise Approach

• Practice in pairs (10 minutes then switch)• Choose scenario that best fits your teaching role

– Clinical: Outpatient Setting• Attending-Student or Attending-Resident

– Clinical: Inpatient Setting• Resident-Student

– Non-Clinical Small Group Teaching Setting• Instructor-Student

– Non-Clinical: Research/Lab Setting• Faculty/Fellow-Student

Small Group Practice Sessions

• Group 1 - Meredith/Barry, Room 370 • Group 2 – Janet, Room 320• Group 3 – Leah, Room 326• Group 4 – Rachel, Room 420• Group 5 – Joe, Room 426• Group 6 – Jules, Rooms 381/382

Fishbowl

Feedback Wrap Up

• Lessons Learned– What went well?– What was challenging?

• Consider “Fishbowl” as a teaching tool• Tomorrow…• Feedback, Part 2 - Giving Feedback and

Developing Individual Learning Plans for Struggling Learners (Laura Hanyok, MD and team)