Feedback & Evaluation: Quick Tips for Clinical Preceptors (Part 1) Shirley Schlessinger, MD, FACP Associate Dean for Graduate Medical Education University of Mississippi Medical Center

You can observe a lot just by watchin. Yogi Berra But things will never CHANGE if you dont comment on what you see!

Why ? ( You know its important!) Performance does not reliably improve without evaluation and feedback Performance does not reliably improve without evaluation and feedback Key responsibility of the clinician- teacher faculty member Key responsibility of the clinician- teacher faculty member ALL of us can get better at what we do… ALL of us can get better at what we do…

Why not? (Our lowest scores as faculty!) I didnt have enough exposure to the trainee I didnt have enough exposure to the trainee I dont know what to say I dont know what to say Am I being fair? Am I being fair? I dont want to hurt their feelings I dont want to hurt their feelings I dont want to hurt their career I dont want to hurt their career I dont want to be sued I dont want to be sued

So…Lets get better!!! Clearly establish expectations for learners Clearly establish expectations for learners Understand the tools you need for evaluation (assess /measure!) Understand the tools you need for evaluation (assess /measure!) Have faith in your learners desire to improve! Have faith in your learners desire to improve! Develop skills in targeted observation and constructive feedback Develop skills in targeted observation and constructive feedback

Feedback Shapes Behavior Timely Timely Objective Objective Focused Focused Useful Useful What did the learner do well? Where do they need to improve? What are next steps they can take?

Prepare Resident for Feedback Why feedback will be given? Why feedback will be given? –Be all that you can be… When will feedback be given? When will feedback be given? –Micro-feedback –Macro-feedback –Formative & Summative evaluations How will feedback be given? How will feedback be given? Provide this info at the BEGINNING of the rotation; STICK to the PLAN!

Micro –vs- Macro Feedback MICRO Instantaneous Instantaneous Pure coaching Pure coaching Flexible format Flexible format May be given in group setting May be given in group setting May occur in response to a single observation May occur in response to a single observationMACRO Cumulative over time Cumulative over time May be formative or summative May be formative or summative Coaching & Judging Coaching & Judging Structured format (competency based) Structured format (competency based) Should be a private session Should be a private session

Micro & Macro Feedback More effective when initiated with self-evaluation More effective when initiated with self-evaluation Should be clearly linked to expectations / goals and objectives Should be clearly linked to expectations / goals and objectives Should be linked to next steps Should be linked to next steps Macro-feedback should build on and reinforce microfeedback! Macro-feedback should build on and reinforce microfeedback!

Microfeedback Template Look for behaviors to reinforce as well as correct Look for behaviors to reinforce as well as correct Provide immediate feedback when possible Provide immediate feedback when possible Be brief and focus on a single issue Be brief and focus on a single issue Be specific about what you saw Be specific about what you saw Avoid speculating on intentions Avoid speculating on intentions Use nonjudgmental language Use nonjudgmental language Encourage self-evaluation and reflection Encourage self-evaluation and reflection Identify next-time behaviors Identify next-time behaviors

Preparing to Give Macro- Feedback Read your residents notes Read your residents notes Consciously observe your residents interacting with families, nurses, pharmacists, social workers Consciously observe your residents interacting with families, nurses, pharmacists, social workers Watch your resident examine patients Watch your resident examine patients Probe your resident for evidence-based decision making Probe your resident for evidence-based decision making Consider patterns of behavior Consider patterns of behavior Consider how your resident has responded to micro-feedback Consider how your resident has responded to micro-feedback Identify a private place to provide feedback Identify a private place to provide feedback

Macrofeedback Template Ask: What do you see as your strengths? What do you see as your weaknesses Ask: What do you see as your strengths? What do you see as your weaknesses Tell: Summarize your observations and ideas; include both positive and negative feedback in each competency domain if possible (even the best resident can get better!!!) Tell: Summarize your observations and ideas; include both positive and negative feedback in each competency domain if possible (even the best resident can get better!!!) Ask: What are your next steps?; guide resident in developing goals for growth Ask: What are your next steps?; guide resident in developing goals for growth

Hints for Tell Focus on observations: You did such and such… versus You are… Focus on observations: You did such and such… versus You are… Focus on descriptions, not judgments: What I observed was… versus Your examination was inadequate because… Focus on descriptions, not judgments: What I observed was… versus Your examination was inadequate because… Focus on specific details, not generalities: At the start of the interview with Mrs. Jones, I noticed… versus Your introductions are all… Focus on specific details, not generalities: At the start of the interview with Mrs. Jones, I noticed… versus Your introductions are all…

DO… Define expectations early Define expectations early Get DATA (Observe, Observe, Observe) Get DATA (Observe, Observe, Observe) LABEL it FEEDBACK! LABEL it FEEDBACK! Target to trainee level Target to trainee level Consider timing Consider timing Give feedback regularly Give feedback regularly Ask for self-evaluation by trainee Ask for self-evaluation by trainee Be positive when deserved Be positive when deserved Be specific as possible Be specific as possible Focus on the clinically significant Focus on the clinically significant Encourage trainee responsibility Encourage trainee responsibility

DONt… Dont be angry when giving feedback Dont be angry when giving feedback Dont give feedback in public or emotionally charged settings Dont give feedback in public or emotionally charged settings Dont try to cover too much Dont try to cover too much Dont lecture Dont lecture Dont be completely negative (NEVER be demeaning…) Dont be completely negative (NEVER be demeaning…) Dont provide compliments only Dont provide compliments only Dont criticize the personality (behavior!!) Dont criticize the personality (behavior!!) Dont ignore problems!! Dont ignore problems!! Dont wait until the end to give negative feedback Dont wait until the end to give negative feedback Dont put negative comments on paper, until discussed in person Dont put negative comments on paper, until discussed in person

Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all… Jack Ende, 1983 Do not ignore problems! They will NOT go away…

And finally… Fill out the WRITTEN evaluations requested by the education office in a TIMELY fashion!! Fill out the WRITTEN evaluations requested by the education office in a TIMELY fashion!! –This is a measure of YOUR professionalism! Provide written comments Provide written comments –Source of motivation for high performers –Road-map for improvement for others –Remembered by learner LONG after numbers are forgotten!!! –Promote personal growth