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Giving Effective Feedback Making A Better Sandwich Sameer Khatri, MD Faculty Development Fellowship Hi, I am…….We are going to talk to you about effective feedback: “making a better sandwich.” Talk briefly about the old P-N-P sandwich.

Objectives Reviewed importance of feedback Defined feedback vs. evaluation Identified barriers to feedback Identified ingredients of effective feedback Applied effective feedback techniques By the end of this presentation, we will have reviewed the importance of feedback, define….. And identified ingredients or (principles) of effective feedback.

Activity #1 Feedback reflection Write down 1-2 words that come to mind when you think of feedback Be prepared to discuss with group So what were the recurring words or themes in your group? Good…these are all good points and we will build on these and go more in detail in this presentation. 2 minutes

Activity #2 Read and highlight what you think are: Reasons feedback is important Principles of effective feedback Ways to give better feedback Be prepared to discuss with group These notable and often quoted articles about effective feedback. We would like you to read and highlight what YOU think are…. Be prepared to discuss possible new ideas or concepts you learned from your article. So…share what you learned… 8 minutes

Feedback: Why bother? “The goal of clinical training is expertise in the care of patients. Without feedback, mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved empirically or not at all." So Why bother? From the article and the group comments, we know that feedback is important. -Ende J: Feedback in clinical medical education. JAMA 250(6):777-81, 1983

Johari Window Known to Self Unknown to Self Self Awareness Feedback Self Awareness Mutual Understanding Open/Free Area (Personal Growth) Blind Area Known to others The importance of effective feedback is further demonstrated by the Johari window model. The Johari Window model is a simple and useful tool for illustrating and improving self-awareness, and mutual understanding between individuals within a group. NOTE! The model empathizes the importance of DIALOGUE in giving feedback. The aim in any group should always be to develop the 'open area' for every person, because when we work in this area with others we are at our most effective and productive, and the group is at its most productive too. The open free area, or 'the arena', can be seen as the space where good communications and cooperation occur, free from distractions, mistrust, confusion, conflict and misunderstanding. Unknown to others Hidden Area Unknown Area

Feedback: What is it? So we now know why feedback is important, but what is it? Are learners and instructors on the same page about what feedback is? Watch and try to remember feedback issues in this video? I agree. There appears to be confusion on what feedback is and the difference between feedback and an evaluation. As we discussed earlier, feedback is the information we get back to help us grow and learn.

Activity #3 Feedback vs. Evaluation Place descriptive words under Feedback or Evaluation Be prepared to discuss with group 3 minutes

Feedback vs. Evaluation Immediate Scheduled Informal Formal Observation Objective Event specific Global performance Improvement Grading Dialogue Monologue Feedback vs. Evaluation This is what we got. As you can see there are seminaries and differences. The key to keep in mind is that feedback is a Dialogue. It is important in order to expand the open arena in the Jahari window

What are your barriers to feedback? Kris: So what are the barriers to giving feedback? These are your responses. As you can see, these are similar to what you just read in the readings. How would you suggest overcoming these barriers (maybe put this question into the slide)?

Effective Feedback What are the ingredients? As we are getting ready to give feedback or give a feedback “sandwich,” we can ask ourselves, what are the principles or “ingredients” of effective feedback?

Principles of Effective Feedback M E T L C Specific Objective Modifiable Behaviors Expected Timely Limited Constructive At this point we have identified most of these key principles or ingredients. We have made these principles into an acronym that may make it easier for you to remember. We like to encourage you to give SOME TLC when giving feedback --Specific- concise, instead of good job, be specific. Your hands shake instead of clumsy.. --Objective-based upon observations and witnessed performance only and not hearsay --Modifiable-focus on behaviors that are modifiable or/and will likely be repeated. You are addressing the behavior, not the individual --Expected-schedule. don’t blind side. Make it expected before an event --Timely-after every encounter or event. Timely also means appropriateness. There is an emotional issues that requires things to cool off a bit. Good timing for feedback also ensures safety for the learner. --Limited. People tend to be able to deal with things in smaller amounts including feedback. Plus it is less time consuming. Give less but more frequent --Constructive-keep in mind that feedback is designed to help the learner improve and should be given for no other reason. Safety is also part of this key principle

Activity #4 In groups of 2, each person pick one scenario Practice SOME-TLC In groups of 2, each person pick one scenario Read and highlight key points you would use when giving feedback Read the following learner observations. Highlight SOME TLC principles in preparation for giving your learner feedback. Save for activity #5 3 minutes

Old Feedback Sandwich Not very palatable Positive Negative So we have our ingredients. How do you we put it together. As discussed earlier the old P-N-P sandwich can be rather dry. Is there a better way? Not very palatable

New Feedback Sandwich Ask Tell / Teach Act So what we propose is the new Sandwich using Ask…

Ask Ask learner to assess their own performance How do you think you did? What do you think went well? Did you have any problems? Good way to start conversation Automatically engages the learner Reveals learner’s insight

Tell / Teach Tell I observed... It seemed as though… When you do __I feel__... Teach (short pearls) In my experience…. Consider… Used to address learners assessments Address positive and negative behaviors Address learners comments after initial “ASK” Non judgmental Focused teaching (short pearl)

Ask Ask learner to reflect and analyze What do you think of… my observations? my comments? What would you do differently? What can we do to improve? Gets learner’s buy in Ensures learner’s understanding Demonstrates mutual respect

Act Summarize key points Demonstrate Re-assess Commit to a plan Feedback without teacher’s willingness to follow up or support is of little value. End on positive note

ASK ASK ACT TELL/TEACH Why Ask-Tell-Ask-Act? With each step there is increase in knowledge flow. Finally the knowledge is then able to be channeled to an action and change TELL/TEACH

Activity #5 Build a new feedback sandwich Use SOME TLC in activity #4 Take turns giving feedback using Ask-Tell / Teach-Ask-Act Now we have our ingredients and a way to build our new feedback sandwich. This exercise… 10 minutes

How did it go? OR

How did it go?

Activity #6 Call to Action List what you will do in the next month to improve feedback to our students Be prepared to share

Objectives Reviewed importance of feedback Defined feedback vs. evaluation Identified barriers to feedback Identified ingredients of effective feedback Applied effective feedback techniques By the end of this presentation, we will have reviewed the importance of feedback, define….. And identified ingredients or (principles) of effective feedback.

Take Home Points Feedback is essential Feedback is desired by learners Effective feedback requires preparation Give SOME-TLC via Ask-Tell-Ask-Act Tien: By the end of this presentation, we will have reviewed the importance of feedback, define….. And identified ingredients or (principles) of effective feedback.

Questions?