Giving Feedback: Dr. A. M. Kadri Professor Community Medicine dept. PDU Govt. medical college, Rajkot

Objectives Describe rationale for giving feedback in medical education Describe rationale for giving feedback in medical education Identify types of feedback Describe principles and strategies for giving constructive feedback Define characteristics of effective feedback Observe and practice giving feedback Discuss common problems in giving effective feedback To review the distinction between “feedback” and “evaluation” So how do we give good feedback. After my talk today, I hope ou will come away with an undderatdnign of what defines effective feedback, as well as an action plan for improving feedback in your own practice. We’ll discuss the barriers and rational for giving feedb and you ‘ll have an oprtunity to observe, crtiqque and even practice this skill. We’ll end with a brief video clip.

Questions for Discussion Why we should give Feedback? What is feedback? What is the role of feedback in teaching and evaluation? Why do we avoid giving feedback? What characterizes effective feedback? What problems do we commonly encounter? How can we improve feedback in our training programs?

Why we should give feedback? Why we should give feedback?

Rationale for Giving Feedback Without feedback, Good performance is not reinforced, Mistakes go uncorrected, Competence is achieved empirically or, not at all. Jack Ende - the father of feedback in medical education -wrote this often-referred-to JAMA article on feedback in 1983. Without feedback, our learners may not know how they are doing, if they are doing well, or if there are elements of their performance that need to be improved so that they can be competent. Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:777-781.

More Rationale High stakes outcomes It is our responsibility High stakes outcomes It is our responsibility It will help learners improve their performance Can enhance the learner teacher relationships GO OVER OTHER POINTS QUICKLY, OR MERELY REFER TO OTHER BARRIERS AND LET PARTICIPANTS REVIEW If students are not corrected on misinfromation and reinfroced for correct information/skills, they can’t learn Learners need to accurately appraise their level of competence.

Definition What is Feedback?

Feedback Communication to another person which gives information about how he/she affects and is perceived by others. A way of helping another person consider changing his/her behavior.

Feedback Communication to another person which gives information about how he/she affects and is perceived by others. A way of helping another person consider changing his/her behavior.

Feedback Provides information Based on observations Descriptive Immediate “Formative” Faculty Development Office Faculty of Medicine ©2001

Reinforcement/ Minimal Feedback Statement expressing positive (or negative) reaction to a behavior which aims to increase (or decrease) the likelihood of that behavior happening again “That was a great presentation” “You need to work on your presentation skills” “Reinforcement or minimal feedback” has a value judgment - positive or negative, but it doesn’t provide the information necessary to get our rocket back on course.

Evaluation Qualitative judgment which ranks a learner’s performance in comparison to other learners Often the only measure of performance visible to the learner Usually given after the performance is over “Evaluation” is more summative, given when the learner does not have an opportunity to demonstrate improvement to the person evaluating them at that time.

Evaluation Provide judgment Involves several methods Evaluation (on a scale) Delayed “Summative”

Feedback (Reinforcement or correction) + Explanation Keeps recipient on course to meet goals Allows recipient to adjust your course to meet goals Given immediately after the performance or at some time soon after, when the learner still has time to demonstrate improvement [Review each bullet with group]

BARRIERS

It is not a part of our culture… Although feedback is a part of many other professional cultures - including sports, dance, theatre - in which a certain performance is required, excellence is rewarded and teachers (caoshes or directors) help you attain that performance. It is not really a part of our culture We certainly have the reinforcement and the evaluation but what of feedback? The literature shows that our learners want it but feel that they generally do not get it. “What feedback? No one ever gives me feedback”.

Why is Feedback often Avoided/Neglected?

Barriers It is uncomfortable Avoid confrontation It is uncomfortable Avoid confrontation Learner will not be receptive No one ever gave me feedback Not quite sure how to do it I hated getting feedback Let’s first define them. I’ll address some now and some in a little more detail later. Not gigng feedback at the time you see it is compliit agreement with it. I. Maybe this medical student doesn’t really need to know how to do a good abdominal exam yet. And the number one survey say, rreason for not giging feedback is that there is not enough time. would argue that it is a time save in the long run and in the short run it donesn’t take that much time

Three types of feedback in medical education Brief feedback - 2-5 minutes On a clinical skill Formal feedback - 5-15 minutes On a presentation, involves a dialogue Major feedback - 15-30 minutes Scheduled mid-point through a learning experience Branch article We should be much more liberal with brief and begin to work on incoprportat more fomal feedback into our teaching Make a conscious effort to plan for and give major feedback. Branch J, Paranjape A. Feedback and Reflection: Teaching Methods for Clinical Settings. Academic Medicine. 2002;77:1185-1188.

What are the Essential Components of Feedback? What are the Essential Components of Feedback? What was done well What could be done better What could be done to improve next time ther is reinforcing feedback…. There is corrective feedback… And most importatntly a plan for future success.

What Makes Effective Feedback?

Elements of Constructive Feedback Make sure that your feedback is: Timely and expected Based on observations Based on changeable behaviors Related to learning goals Limited in quantity

The Old Feedback Sandwich Praise Criticism Is it more palatable? The problem here is that it really become s junk food. The probme is that our learners are not involved in this sanwich delivery , we’re treatign them like a non thinking, rocket.

The New Feedback Sandwich* Ask Tell An alternative is a different sandwich the orgins of which lie in the communication skills literature - ask-tell-ask is a model for givng patient information. This feedback sandwich is easier to swallow because it involves a dialogue between patient—as well as between teacher and learner. Adaptation of “The New Feedback Sandwich,’ common in patient-physician communication literature; adapted by Lyuba Konopasek, MD, for use in feedback settings.

In Closing Keep personal needs and feelings out Monitor your reactions Do not overload Time your feedback appropriately Teach self-critique

Criteria for Effective Feedback In general, feedback should be: Specific not General Immediate not Delayed Behavioral not Inferential Descriptive not Evaluative More or less not Either – Or Asked for not Pushed Upon

There is no single recipe for success. Faculty Development Office Faculty of Medicine ©2001

Feedback should be given in a way that the receiver can hear it, understand it, and choose to use or not use it.

Now It’s Your Turn!