Five Microskills of Effective Feedback Focus on SBIRT Maureen Strohm, MD, MSEd with thanks to Julie G Nyquist, Ph.D.

Afternoon Objectives By the end of the session participants should be better able to: Teach in relation to SBIRT Utilize the 5 Microskills during Clinical Teaching encounters Provide effective feedback to family medicine residents in an office-based setting http://www.residentteachers.com/Content/ContentMenu.asp

Elements of All Behaviors Knowledge Skill Behavior Environment Attitude (confidence, willingness)

Teaching/Learning Techniques Outpatient Clinical Settings Role modeling One-to-one precepting Observation & feedback Case presentation & feedback Direct Patient Contact

Clinical Teaching Three basic phases: Planning and preparing for instruction Implementing instruction Evaluating learner outcomes

Clinical Teaching - Basic Principles Establish positive learning environment Establish rapport - as with patients Communicate expectations (2-way) Assess learner readiness and motivation Collaborate with learners - keep the teaching/learning process learner-centered Provide feedback and formally evaluate

Using the Five Microskills for Formative Feedback Step 1. Get a commitment - Motivate the learner Step 2. Probe for Supporting Evidence Step 3. Teach general rules – eg., DEATH, SOBER Step 4. Reinforce positives Step 5. Correct mistakes … following self-critique John Neher, 1992 – model for clinical teaching within time constraints: Precepting provides opportunities to teach “ways of thinking” as well as info. Recognizes “teachable moments”

Step 1. Get a commitment What do you think is going on with this patient? What would you like to do? Even a hunch or a guess is better learning than no commitment

Step 2. Probe for Supporting Evidence What led you to that diagnosis? Why did you choose that drug? Helps teacher identify what the learner does … and does not know Must not be unpleasant

Teach general rules DEATH SOBER

Step 4. Reinforce positives Reinforce what was done right Must reward specific competencies observed Forms basis of the “sandwich”

Step 5. Correct mistakes Elicit self-critique first Best done in private Be SPECIFIC about behaviors observed & behaviors desired (“meat” of sandwich) Empower learner – work together to develop a concrete plan for growth

Providing Verbal Feedback MI Hints Seek first to understand Resist the urge to immediately correct Listen to your learner Empower your learner

Teaching Demonstration Steve Learner’s interview with patient (video) Focus on key elements of SBIRT Learner’s use of MI Modeling of feedback Watch feedback process Watch for preceptor’s use of MI Monitor performance via Microskills checklist

Group Role Play Video Trigger Starts with video interview with patient All small group members are collectively “The Preceptor” Use progressive interview technique One person starts as The Preceptor Time out when have a Q or time to move on Only the facilitator and The Preceptor (of the moment) can call a time out/time in During time out - learner is “asleep” Done – discuss the process and observations

Questions and Answers

Take Home Messages Use SBIRT in your care of patients Model MI with patients and learners Utilize the Five Microskills with learners Encourage learners to use MI and SBIRT Collaborative teaching is similar to MI Collaborative, Empathic, Respectful Limited by learner readiness