Effective Feedback Win May, MD, PhD Beverly Wood, MD, PhD Division of Medical Education Keck School of Medicine University of Southern California

Objectives Perform a self-assessment of your feedback skills Discuss your use of feedback as a teaching tool Discuss barriers to feedback Practice giving effective feedback

Feedback: 3 definitions Concept Characteristic Information - Focus is message content Reaction - Focus is interaction with information Cycle - Focus is receiving information, responding to data, and improving response quality J M M van de Ridder et al(2008)

Feedback: Definition Guide for teachers and students Focus for learning activity Developmental guide to achievement

Feedback What students have achieved What students might achieve What students are ready to achieve (Crooks, 1988)

Feedback: Goal Support and foster students self-directed learners

Objectives of Feedback Helps learners to: Determine expected standards Identify gaps between standard and actual performance Improve learning and performance Helps teachers to: Adapt teaching to learners needs Keep up with learners progress

What is NEEDS What ought to be

Professional standards/ guidelines External indicator charts What is believed to be real… Personal standards Personal perceptions Fox, R.D. and Miner, C. Motivation and the Facilitation of Change, Learning and Participation in Educational Program for Health Professionals. Journal of Continuing Education in the Health Professions, Vol. 19, No. 3. Summer 1999

In other words…… Feedback in clinical education is: Specic information about the comparison between a trainees observed performance and a standard, given with the intent to improve the trainees performance. J M M van de Ridder et al(2008)

Faculty barriers to feedback Time constraints Absence of standards for competent performance Lack of direct knowledge of learners performance Discomfort in giving constructive (negative) feedback Unfamiliar with providing effective feedback

Learner concerns with feedback Non-specific - does not help learning or performance Personal - statement about worth or potential (embarrassing or humiliating) Not linked to learning outcomes Not timely - too late to change performance Not progressive - no sense of what they have achieved in progress towards a goal or have yet to achieve.

Activity On the card, as a pair, write what you consider to be the basic principles of feedback.

Principles of feedback 1.Planned - learners need to know when feedback will be given who will give it what will be given how it will be given

Principles of feedback 2.Timely and prompt - as closely as possible to performance. 3.Specific - describes behaviors. 4.Constructive -provides guidelines for improvement. 5.Limited to changeable behaviors. 6.Manageable - 1 to 3 behaviors.

Principles of feedback 7. Empathize with learner 8. Verify - learners understand feedback. 9. Plan - action plan with learner. 10.Follow up - check with learner on achievement of plan.

Timing of feedback During/soon after patient contact End of each half day or day Mid rotation End of rotation

Who can contribute? Self Peers Faculty Other team members 360-degree feedback

Feedback Session Be clear about purpose Get learners perspective on how things are going Use sandwich technique Ask recipient to rephrase feedback Ask recipient for solutions Develop a learning plan together Schedule a follow-up meeting

What would you consider as ineffective vs effective feedback?

Ineffective vs Effective feedback Ineffective Effective Competencies that are Well observable tasks and not observable competencies Uninformed or non-expert Expert observer and observer feedback provider Global information Highly specic information Implicit standard Explicit standard Second hand information Personal observation No aim of performance Explicit aim of performance improvement improvement No intention to re-observe Plan to re-observe

Without feedback, mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved incidentally or not at all. Jack Ende, 1983

Case Scenario John is a very energetic learner, to the point of being aggressive. He prepares extensively for teaching sessions, reads exhaustively and participates actively in discussions. In fact, he tends to monopolize discussions often ignoring comments of his classmates. In pairs, discuss how and what feedback you will give to him.