Pharmacy Precepting Pearls of Practice Providing Criteria-Based Feedback Lanita S. white, pharm.d. Assistant professor, department of pharmacy practice Director, 12th Street health and wellness center University of arkansas for medical sciences

Objective Explain how to provide timely, constructive, and criteria-based feedback effectively.

What is it and why do we do it?

A Few Definitions… Provide Supply; Make adequate preparation for; Make available for use Criteria A principle or standard by which something may be judged or decided Base Have as the foundation for; Use as a point from which development can occur Feedback Information about reactions to a product, a person's performance of a task, etc., used as a basis for improvement

What is Criteria-Based Feedback? Making available for use, by the student or resident, information about performance of assigned tasks to be used as a basis for improvement guided by the principles and standards set forth by the college or residency program.

It is not… Encouragement – Vague and does not focus on students’ skill development Evaluation – Renders judgment, often occurs at the end of an activity (summative) and hinders remediation, is often expressed in a normative fashion comparing students, and can be vague Constructive criticism – Describes the negative behaviors or actions of another and the effects that this behavior has on others; is grounded in empathy but it can emphasize the negative and ultimately create communication barriers Self-reflection – Without feedback may not help students notice behaviors that they need to improve Encouragement: “You did a good job” is encouragement (Preceptors tend to use this statement when they feel uncomfortable discussing poor performance)

Reminder – It is… Making available for use, by the student or resident, information about performance of assigned tasks to be used as a basis for improvement guided by the principles and standards set forth by the college or residency program.

Why is it necessary to do this? ACPE – Accreditation Council for Pharmacy Education (2016) (Released February 2015) Didactic Curriculum: Standard 24: Assessment Elements for Section I: Educational Outcomes Standard 25: Assessment Elements for Section II: Structure and Process Advanced Pharmacy Practice Experience: Appendix 2: Expectations within the APPE curriculum Colleges and schools assess student achievement of APPE competencies within their assessment plans using reliable, validated assessments. Formative feedback related to specific performance criteria is provided to students throughout the experience. At a minimum, performance competence is documented midway through the experience and at its completion. Didactic Curriculum: Standard 24 (assesses educational outcomes) - includes an assessment of student readiness to enter APPE’s, provide direct patient care and contribute as a member of an interprofessional patient care team Standard 25 (assesses structure and process) – includes an assessment of clinical reasoning skills and APPE readiness APPE’s:

Why is it necessary to do this? ASHP – American Society of Health-System Pharmacists (Released September 2014) Standard 3: Design and Conduct of the Residency Program Standard 3.4: Evaluation Initial Assessment Formative (on-going, regular) assessment Summative Evaluation Resident’s Development Plan

Student vs. Resident… What’s the difference?

Student or Resident – Where should they be, what should they know? Learning where to find the information Reviewing basic concepts of disease states Learning how to put pharmacy school knowledge into a usable format Should be able to manage several patients/tasks with practice RESIDENT Should know where to find or how to find it Should be able to teach basic concepts of disease states Learning how to put pharmacy school knowledge into a usable format Should be able to manage several patients/students/tasks

Providing Feedback

Tips for successful feedback sessions Be prepared with clear examples and notes for clarity Open meeting effectively Encourage participation and self- assessment Reinforce desired behaviors Clearly define undesired behaviors Problem solve together, provide suggestions as preceptor Assess recipient’s understanding and acceptance of the feedback Allow for questions and clarification Acknowledge perspective and feelings Close the meeting effectively Before starting you will do the things Dr. Young and Waggoner have discussed including: Establish a relationship, open communication and common vocabulary Evaluate based on defined and expressed expectations Open meeting effectively Assess recipient readiness, promote rapport Establish agreed upon purpose of the meeting Close meeting effectively Summarize positives and areas/methods for future growth Make plans with recipient to follow-up / assess progress

Tips for successful feedback sessions Be aware of yourself and how you are perceived: Demonstrate positive regard for recipient Involve recipient in process Focus on specifics, not generalizations Use descriptive, non-judgmental language Label subjective data as such Focus on remediable behaviors, feasible solutions Limit amount of feedback to three or fewer observations Be aware of own subjective feelings and assumptions, and manage them appropriately Listen, understand recipient’s perspective and feelings

Addressing Performance Issues

Addressing Performance Issues Acknowledge awkwardness and discomfort State performance Issue Elicit and listen to individual’s self assessment Acknowledgment or Dismissal of Problem

Addressing Performance Issues Acknowledgement of the Problem Step 1 Define and analyze the problem together Step 2 Problem solve together Step 3 Make a plan to address with defined outcomes and timeline Document feedback, plan and time to re-address

Addressing Performance Issues No Acknowledgement of the Problem Step 1 Recognize/control your own emotional reaction Step 2 Acknowledge individual’s emotions and perspective Step 3 State your perspective, make a plan to address with defined outcomes and timeline Document feedback, plan and time to re-address

Let’s Practice

P4 Student on APPE Rotation You require students to obtain a complete medication history from patients as part of their fourth-year advanced pharmacy practice experience at your site. During the discussion of the patient, one of your students clearly only documented the medication names and did not evaluate the dose, timing, reason for use, patient adherence or patient understanding of the medications, which was a vital component of the instructions. You are upset because this student has neglected this information in the past, and you have told him or her to include it in the future. You abruptly end the conversation and tell the student to go figure out what is missing and return to you when they are ready to have an informed discussion.

P4 Student on APPE Rotation Review student’s understanding of expectations to ensure clarity Ask what elements the student/resident thinks should be included and why Discuss elements preceptor thinks should be included and why Reconcile the differences and reasons Point out exact missing elements and discuss what should be different – problem solve If possible, re-attempt and re-evaluate the exercise as soon as possible and reinforce positive behaviors Document and compare periodically and at the end

PGY1 Resident on Rotation You are a residency preceptor at your hospital. You ask the resident on your rotation to develop a plan for a new service you plan to start. The resident submits the plan to you, but it does not include the specific features that you asked for. You perceive this resident to be sensitive, and you do not want to sound unappreciative or critical. So you tell the resident, “Thank you for working on this. There are a few things missing, such as how patients can be referred to us, but it looks good.”

PGY1 Resident on Rotation Review the specific elements you asked for and what has been presented Encourage self-assessment Determine which elements are missing and why Problem solve to get the desired results Assess understanding Be open to comments Review and Redo

Consider how you would evaluate… Student/Resident that does “everything right”. Student/Resident that “knows it all”. Student/Resident that seems to need additional help or even remediation. Residents and students on rotation at the same time. Students on rotation at the same time. Evaluating presentations and in-services. Evaluating personal behaviors that are inappropriate. Students/Residents with medical/mental complications.

Question All are tips for successful feedback sessions except: Encourage participation and self-assessment Provide vague examples of expectations Reinforce desired behaviors Acknowledge perspective and feelings

References Accreditation Council for Pharmacy Education Standards 2016 - https://www.acpe- accredit.org/deans/StandardsRevision.asp American Society of Health-System Pharmacists Accreditation Standard PGY1 - http://www.ashp.org/DocLibrary/Residents/ASO-PGY1-Residency-Accreditation-Standard.pdf Providing feedback to enhance pharmacy students’ performance. Am J Health Syst Pharm December 15, 2007 64:2542-2545; doi:10.2146/ajhp070316 Chur-Hansen A, Koopowitz LF. Formative feedback in teaching undergraduate psychiatry. Acad Psychiatry. 2005; 29:66–8 Kern DE. Confronting Individuals About Performance Problems. Johns Hopkins Faculty Development Program for Clinician-Educators. (Supplement to Handout) Eliciting Feedback. Johns Hopkins Faculty Development Program for Clinician-Educators. (Supplement to Handout) Staying Alive in Principle Five: Ideas on Where to Begin; http://www.ashp.org/DocLibrary/Education/Webinars/Pearls-Residency-Preceptors.aspx

Pharmacy Precepting Pearls of Practice Providing Criteria-Based Feedback Lanita S. white, pharm.d. Assistant professor, department of pharmacy practice Director, 12th Street health and wellness center University of arkansas for medical sciences

Questions? Kim Young, Pharm.D., BCPS Debbie Waggoner, Pharm.D., BCNP Lanita White, pharm.D.