Beyond Cheerleading: How to be a coach to your residents by giving effective feedback Angela Cheng-Lai, PharmD, BCPS Clinical Pharmacy Manager Montefiore Medical Center Assistant Professor of Medicine Albert Einstein College of Medicine Bronx, New York May 3, 2016

Disclosures There is no commercial support associated with this educational activity The presenter has no relationship with any commercial company

Objectives To identify barriers to effective feedback and how to overcome them To describe various characteristics of effective feedback and how a preceptor can incorporate them

Definition of Effective Feedback Information that helps the trainee to build on skills and behaviors Clarifies the trainee’s awareness of their developing competencies Enhances the trainee’s self-efficacy for making progress Challenges the trainee to set goals for improvement Facilitates the trainee’s development of strategies to enable improvement

Barriers to Effective Feedback Avoidance of “negative” feedback Emphasis of being special Constraints with time Limitations on training/experience

Overcoming Barriers Enlist the learner as an ally Ensure development of adequate, reflective thinking skills Acknowledge the importance of feedback and make time for activity Create forums to share knowledge/experience

Approaches to Feedback Feedback sandwich Pendleton method Reflective feedback conversation Agenda-led outcome-based analysis Feedforward interview

Feedback Sandwich

Do’s for Feedback Treat feedback as a conversation Establish mutually agreed goals Provide well-informed feedback Offer well-timed feedback Tailor feedback to individual Give specific feedback

More Do’s for Feedback Ensure that feedback is actionable Provide the right amount of feedback Include suggestions for improvement Attend to trainee motivation Engage the trainee in a reflective conversation Encourage trainees to seek feedback

Don’ts for Feedback Assume that a single approach will be effective Provide feedback without follow-up Provide feedback that is based on hearsay Underestimate the emotional impact of feedback

Assessment Question #1 Which of the following is the best approach to giving negative feedback: Minimize negative comments to avoid an emotional reaction Sugar-coat the truth and make negative feedback more tolerable Avoid negativity like a plague Enlist the learner as an ally and give comments based on behavior that is remediable

Assessment Question #2 Which of the following is an example of an effective feedback: “You are a disaster waiting to happen!” “My pharmacy technician told me that you are too quiet. Therefore, you probably did not contribute much during rounds.” “You seem to struggle on Mondays due to an increased patient load from the weekend. You should arrive 1 hour earlier on future Mondays to ensure all patients are reviewed effectively prior to rounds.” “You need to be more prepared for rounds.”

References and additional resource list Wilkinson ST, Couldry R, Phillips H, et al. Preceptor Development: Providing Effective Feedback. Hosp Pharm 2013;48(1):26-32 Buck B, Wilkinson ST, Phillips H. Preceptor Development: Providing Effective Feedback, Part 2. Hosp Pharm 2014;49(6):521-529 Lefroy J, Watling C, Teunissen PW, et al. Guidelines: the do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ 2015;4:284-299 Anderson PA. Giving feedback on clinical skills: Are we starving our young? J Grad Med Educ 2012;4(2):154-8 Schartel SA. Giving feedback – An integral part of education. Best Pract Res Clin Anaesthesiol 2012;26(1):77-87 Wenrich MD, Jackson MB, Maestas RR, et al. From Cheerleader to Coach: The developmental progression of bedside teachers in giving feedback to early learners. Acad Med 2015;90(11 Suppl):S91-7

Thank you! Questions/Comments?