Training Trainers and Educators Unit 4 – Giving Feedback Aim Provide the opportunity to develop feedback skills Learning outcomes List the principles to be considered when giving feedback Apply effective feedback skills in the context of their own practice Slide 4.1 You will be familiar with the content of this topic. Outline tutor notes are provided but the expectation is as an experienced facilitator you may wish to add/change to suit your own and audience needs.

Feedback as part of assessment of learning Feedback as Formative evaluation Provides information during learning to measure progress towards a goal and identify areas for improvement. Assessment as Summative evaluation End of learning to measure individual attainment against a specific learning goal In reality there can be an overlap Adapted from Duffy et al 2004, Van der Vleuten and Schuwirth 2005 Slide 4.2 Assessment and feedback are often used interchangeably but we are going to focus on feedback as a formative approach to guide student learning. Explore participants understanding of the terms ‘Formative’ and ‘Summative’ and related experiences ? Never the less, the overlap is where a lot of us will be working. Feedback is almost a type of assessment in someway which we are likely to use within our everyday practice.

“Your work is both good and original.” Subtle Feedback “Your work is both good and original.” “Unfortunately the bit that is good is not original and the bit that is original is not good.” Anonymous Slide 4.3 Giving feedback is an essential skill that facilitators can learn. We can avoid getting it wrong with the correct use of words. Ask participants to share less subtle feedback which they might have experienced

Feedback Sandwich Identify what went well. Then suggest something that would benefit from change. Then reinforce positive messages. Slide 4.4 One of the commonly used approaches to giving feedback is the ‘feedback sandwich’, discuss if anyone used or experienced this? First give the good news - What they have done right and well, Why it was right, Clear, Specific, Personal , Honest Then give them the alternative news - Need to know what they have done wrong or poorly, what could be changed. Identify what led to poor performance, Develop a new approach to enhance performance, Enable a change in behaviour, Specific, Constructive, Kind, Honest End on good news- Be encouraging, move forward, work together Research with students suggests they need to hear 5 positives to one negative or all they will hear is negative, so een if there are lots of things you could mention to change just pick one. Research with students suggests they need to hear 5 positives to one negative or all they will hear is negative. Even if there are lots of things you could mention to change just pick one. May be enhanced by using SMART concept which we will come on to.

Pendleton’s Rules Briefly clarify matters of fact The learner goes first and discusses what went well The trainer discusses what went well  The learner describes what could have been done differently and makes suggestions for change   The trainer identifies what could be done differently and gives options for change Pendleton et al 1984 Slide 4.5 Not totally dissimilar from the feedback sandwich. group discussion: Can you see some of the advantages to this approach? Link to: Conscious competence model, learner engagement/motivation. Strengths: 1. Learners have the opportunity to evaluate their own performance. 2. Allows initial learner observations to be built upon by the trainer. 3. Ensure that strengthens and weaknesses are explored equally. 4. Deals with specifics. 5. Can enable agreement in relation to strengths and weaknesses and areas for development. Facilitate group discussion: Can anyone see any potential disadvantages of using this approach? Challenges: 1. People may find it hard to separate strengths and weaknesses (lack of learner insight, unconsciously incompetent). 2. Using a formulaic approach can interrupt thought processes and perhaps cause the loss of important points. 3. Feedback on weakness is held back but this is the area that the student wants to focus on and is keen to hear. 4. It’s artificial to protect the learner. 5. It reduces the effectiveness of feedback on strengths (as student distracted by their priorities or the feedback given in relation to weaknesses). 6. The trainer may be focused on covering all four steps which may reduce in-depth exploration of priority areas (process driven as opposed to learner-centred).

BOOST Feedback Model Balanced: focus not only on areas for development, but also on strengths. Owned / Observed: provide feedback based only upon behaviours that you have observed. Objective: avoid judgments and relate your feedback to observed behaviours only, not personality. Specific: back up your comments with specific examples of the observed behaviour. Timely: give feedback soon after the activity to allow the learner the opportunity to reflect on the learning. Slide 4.6 Here’s another model. As per slide; discuss key features and seek participants views relating to this model. This short video covers the BOOST model https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=video&cd=1&cad=rja&uact=8&ved=0ahUKEwjtysy1vqXOAhXsDMAKHRQHDfMQtwIIHDAA&url=https%3A%2F%2Fvimeo.com%2F44372998&usg=AFQjCNGeOqcw5dxrL6E8XHApmNZZvTgOdw&sig2=Grl3qlmBXeYS_6eTObiovw&bvm=bv.128617741,d.d24

Non-judgemental Feedback Descriptive v Evaluative Specific v Generalised Behaviour v Personality Explore choices v Telling what to do Slide 4.7 Choose the time and give in a quantity that can be coped with Check feedback is understood Avoid collusion This fits with the BOOST model, in relation to a focus on observed behaviours and being objective in the delivery of feedback See unit 4, handout 1

Feedback exercise Slide 4.8 Feedback Scenario   Role play exercise notes - Mentor to learner feedback:   Where possible, two facilitators role play this scenario - the “mentor” dominates the dialogue. The “learner” may try to interrupt and change course of the conversation but is unsuccessful. Please note that the scenario is overemphasising the behaviours.  If only one facilitator is available, it may be possible to ask for participant volunteer but ensure they are comfortable with proposed role play scenario.  Request that participants observe the role play and note their observations/emotions about any aspects of good practice/poor practice or areas for improvement and that we will discuss after exercise.  Basic script:  I glad I caught you today (insert name) because I really need to speak to you about how things are going. Look, the standard of you work is not acceptable and actually I’ve heard people saying that they don’t think you’re performing to the same level as the others students we’ve had on placement here.  Yes, ok sometimes you do work well and I can see that, but then just today I have found another mistake in your work. This is the fourth or fifth mistake I have noticed this month.  I know we’re busy and I’m sure we spoken before about this, but the impression I get is that you never listen to my suggestions or guidance.  Not only that but I think we should talk about your manner. I’ve been getting complaints about your attitude since you’ve arrived on placement. I’m not having you upsetting your colleagues like this.  Facilitated discussion:  After role play, facilitate discussion around views, experiences, emotions, what was good, what needs improvement and how the feedback process could have been delivered more effectively.  Ask the group to reflect on BOOST and other feedback models and consider:  Is it balanced, observed, objective or specific, or timely? Thoughts about the learner – educator relationship, communication methods, and assumptions made relating to perceived behaviour. 

Scenario using BOOST exercise “Your work is not acceptable” “Work well” “I have found another mistake in your work. This is the fifth mistake I have noticed this month.” “You never listen to my suggestions and guidance.” “I think we need to talk about you manner. I have been getting complaints about your attitude since you’ve arrived on placement.” “I’m not having you upsetting your colleagues like this.” Slide 4.9 Facilitate the group to consider the scenario and using the BOOST model to develop suggestion as to how they could change this scenario to reflect effective feedback. “Your work is not acceptable” Alternative suggestions: 1. How do you think your performance has been? 2. I have concerns about aspects of your work. I think we should review your learning action plan. 3. I am really happy with…let’s see how we can bring…up to the same standard. “Work well” instead you should be specific here, outline key aspects that have been observed. Alternative suggestions: 1. I notice that you are progressing with your communication skills for example: at patient handover you were very clear about the progress the patient has made and identified the care needs to the next team. 2. I heard that you had very successfully liaised with the homecare team about the patients discharge. “I have found another mistake in your work. This is the fifth mistake I have noticed” Alternative suggestion: 1. I have noticed that there have been a few aspects of the care that you haven’t followed through on. I wonder if you feel that you need a bit more support with these aspects, for example… 2. You can organised the discharge of Mr X very successfully but we received feedback from the district nurse that Mrs Y’s was unsure of what medication to take when she was discharged home, I wondered if we should make sometime to review the discharge process and the available patient information. “You never listen to my suggestions and guidance” Alternative suggestions: 1. I am not sure how successful you have been able to take on my previous suggestions should we look at developing a agreed action plan. 2. We have had discussion before regarding … I wonder how to ensure that the you have understood the guidance. “I think we need to talk about you manner. I have been getting complaints about your attitude since you’ve arrived on placement.” Alternative suggestion: I have had feedback about how you spoke to Nurse H, as she felt you were dismissive of her offer of help, I wondered how you felt about this situation? “I’m not having you upsetting your colleagues like this” Alternative suggestions: There appear to have been some disagreement on Friday regarding the transfer of Mr W, I’ve had feedback from colleagues that you were more interested on going on your break than helping out in that situation. Could I hear your view on this as we can look at how we can work more effectively as a team.

Factors influencing objectivity of feedback Criteria being measured Halo and Horn Effects Hawthorn Effect Contrast Effects Stereotyping Slide 4.10 Criteria being measured- It is important that you are clear to the learner about the kind of evidence you are looking for and that it aligns with their learning outcomes. Does the feedback relate to and inform achievement of the learning outcomes? Are the criteria known and understood by learners and the reviewers? Halo and Horn effects- Preconceived ideas about an individuals performance can lead to inaccurate judgements being made. These ideas may be based on the fact that you like the individual or their characteristic traits – that they have a halo – or horns the opposite. Remember this when you give a ‘feed-forward” report to the next facilitator - only focus on performance criteria, not personality! Hawthorn effect - Students may well act differently when they know they are being assessed. Example of study based in a production factory. Contrasting effects - The assessment should be individualised against the agreed criteria. It is important to remember that the student should not be compared to any other who may also be being assessed. Also refers to being assessed against past students. Stereo typing - e.g. different expectations BREAK

Theories of Learning Behavioural: Functional and Scientific, Empirical and Measurable Cognitive: Learning relates to the cognitive stage of development and how people learn Slide 4.11 Behavioural Learning Theories: Implies the dominance of the teacher These theories are based upon the works of theorists such as Pavlov’s theory of classical conditioning and his dogs response to unconditioned and condition stimuli. At the sight of food (unconditioned stimulus – reflex- ), the dogs salivated (unconditioned response). However, when the sound of a bell (conditioned stimulus) was introduced just before the food was presented, the dogs eventually became conditioned, salivating at the sound of the bell alone. The dogs had therefore learnt an automatic conditioned response to salivate at the sound of the bell. Skinner and Watsons theory of Operant Conditioning is the process whereby the probability of behaviour being repeated is increased. Positive reinforcement (reward) is more effective in learning than punishment. Negative reinforcement can also be effective if it is reinforced. A new response is attached to an old behaviour which can be positively or negatively reinforced. E.g. Praise is a positive reinforcement for behaviours, where as a child's tantrum behaviour may be negatively reinforced by ignoring the behaviour. In relation to applying this to teaching and learning theory, the aim of learning is to change behaviour/performance So if someone is learning a clinical skill, the teacher encourages them through praise, the learner practices the skill and the reward is the achievement of ‘competence’. Cognitive Theories: Are interested in how people learn, the stages of learning, their aptitude and capacity to learn and their learning styles. The basis of this educational approach is known as constructivism which is about how the learner understands things and also how understandings grow out of social encounters and therefore how they construct their own learning. One of the key theorist was Piaget’s who undertook research with children and developed the Stages of Cognitive Development from 0 – 15 years in which the complexity of their thinking develops. A number of theorist have built upon this since as Piaget only based his theory up to adolescent development. The other theories are based upon the influence of human development and memory function and their capacity to influence learning. As more learning takes place it is assumed the level of learning will become higher. Bloom’s Taxonomy describes this very well as it articulates the different levels of learning moving from a knowledge base to application of knowledge.

JOHARI Window http://www.businessballs.com/johariwindowmodel.htm Slide 4.12 PLEASE USE LINK ON HANDOUT 2 FOR INFORMATION ON JOHARI WINDOW FOR THIS SLIDE