Improving Performance Through Feedback Anita R. Webb, PhD JPS Family Medicine Residency Fort Worth, Texas

OBJECTIVES 1. Review basic steps for providing effective feedback. 2. Explain the skills for conveying constructive criticism. 3. Clarify the connection between feedback and professionalism.

Key Points Effective evaluation promotes learning. Interpersonal and communication skills enhance effectiveness of evaluation. Learner-centered evaluation encourages development of self-evaluation skills. Learner-centered evaluation is less threatening and may be more effective. The “feedback sandwich” is a helpful tool.

Types of Evaluation 1. Summative Evaluation: “Final Score” –Rates the final performance/product –No opportunity for improvement 2. Formative Evaluation: “Time Out” –Guides performance prior to completion –Allows in-process correction –Facilitates improvement of ongoing behavior

Formative Evaluation Feedback is formative evaluation. Quality feedback promotes performance improvement and professionalism. Quality feedback guidelines (basic rules) –Objective –Timely –Frequent –and of course Accurate

“Feedback” Definition Electronics –The process of returning part of the output of a circuit, system, or device to the input, –In order to Oppose the input (negative feedback) or Aid the input (positive feedback)

Feedback Definition (cont.) Psychology - Knowledge of the results of any behavior, - Knowledge of the results of any behavior, - Considered as influencing or modifying further performance

Professional Development Experience can be a powerful teacher. Experiential learning is the basis of professional development. The educator’s role is to provide: –Experiential learning opportunities –Accurate, timely evaluation Quality feedback promotes professionalism.

Professionalism (cont.) Professionalism requires development of an ability to judge one’s own performance critically. “This is achieved by the adopting of supervisors’ standards until the resident can assess his own performance accurately.” “Residents need to be apprised of their development in these areas so that they may develop an ability to evaluate themselves.”

Professionalism (cont.) “This can be facilitated by accurate and timely feedback from those responsible for training.” –Brent DA. The residency as a developmental process. Acad Med 1981;56(5):

Feedback Loop “When you’re screwing up and nobody says anything to you any more, –“That means they’ve given up on you.” Offer learners a “feedback loop for life” –Randy Pausch, PhD. The Last Lecture. New York: Hyperion 2008, pp –Professor of Computer Science at Carnegie Mellon University

Loops (cont.): Self-reflection “The only way any of us can improve…is if we develop a real ability to assess ourselves” (Pausch p.112) “I was constantly helping my students develop their own feedback loops. It was not easy. Getting people to welcome feedback was the hardest thing I ever had to do as an educator.” (p. 113)

The Feedback Process I. Establish a positive learning environment Using Interpersonal Skills Learners are more receptive to feedback when they feel that you understand and respect their concerns.

Process (cont.) II. Stimulate learner’s INSIGHT Encourage self-reflection Help them identify their learning needs. Ask: “How are things are going?” –“What will help you learn in this setting?”

Learner Insight (continued) Discuss with learner: Problems that may interfere with learning –Personal: health concerns, family issues, etc. –Environment: e.g. system logistics How to balance learner’s needs with: –“System” (e.g. hospital, residency) needs –Other requirements (rules, regulations)

Self-Reflection

III. Feedback Sandwich THREE STEPS 1. FIRST: Start with a positive statement. –Identify what learner is doing well. 2. THEN: Address what needs improvement. 3. FINISH: With a positive statement. Congratulate learner on progress. Express your confidence in learner.

IV. Follow-Up Schedule timely meetings to review progress toward learning goals. Review existing goals. Verify mutual understanding. Invite learner to reflect on progress. Offer observations via feedback sandwich.

Follow-Up (continued) Verify learner’s understanding of feedback. –Ask learner to summarize what you said. –Clarify as needed. Invite learner to comment on your feedback. –Discuss learner’s comments. –Reinforce interactive participation. Re-negotiate learning goals as needed.

Feedback Summary Provide feedback sessions that are timely. Encourage learner’s self-reflection. Focus your feedback on learner’s goals. Acknowledge when feedback is subjective. Be specific: preferably cite observable behavior Avoid overloading learner: limit your points. Check for understanding. Elicit learner’s reaction to your feedback.

Additional Goals Convey support when providing feedback. Ensure that the meeting is a positive experience, even if your feedback is disappointing to the learner. Help learner develop a plan to turn feedback into constructive behavior.

KEY POINTS Effective evaluation promotes learning. Interpersonal and communication skills enhance effectiveness of evaluation. Learner-centered evaluation encourages development of self-evaluation skills. Learner-centered evaluation is less threatening and may be more effective. The “feedback sandwich” is a helpful tool.

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