Feedback in Medical Education Ravi Seyan

Introduction giving and receiving feed is a a part of learning at all levels It is especially applicable when learning a practical skill To improve performance Without expert observation and feedback, learning by doing becomes merely a process of trial and error Which may result in important untoward consequences Without feed back mistakes go uncorrected Good performance is not reinforced

What is feedback? It is a process in which an informed individual comments on another person’s performance and its impact on others In Education- the aim is to make the learner aware of his/her current standard of performance and areas of improvement

Why feedback? Improves learners motivation- learners wants to know how they are doing Corrects mistakes – ensures that the appropriate standard of knowledge, competences are reached Provides reinforcement – of what has been learnt

Feedback Vs Evaluation Feedback and Evaluation are often used interchangeably Feedback gives information not judgement Feedback is formative Evaluation is summative Evaluation is judgemental ( how well a student met a given goal)

Emotional reaction Negative evaluation humiliation Craving for praise- positive feedback Negative feed back makes us insecure

Approaches to feedback The sandwich approach Pendleton’s Approach The Agenda –led approach The Set-Go Approach

The sandwich approach This approach, commonly involves sandwiching negative comments between positive statements. Positive NegativePositive E.g. You elucidated the key components of the patient's past medical history, but you did not recognise the patient’s discomfort when she mentioned that her mother died of the complaint six years ago. However you maintained a calm and even pace within the consultation and came to a confident close.

Pendleton’s Approach Pendleton’s (1994) rules are most widely used Originating from the teaching of consultation skills Provide good points first Student to provide self-assessment Before anyone else Recommendation-what could be done differently Rather then –what was wrong, bad or omitted

Pendleton’s Approach Briefly clarify matters of fact with learner Invite learner to say what to say what s/he has done well and how Ask for comments on what the learner has done well from others( fellow students, colleagues) Ask the leaner to identity what could be done differently and how Allow others to add comments

Kurtz et al teaching and communication skills chapter5 The Agenda-led approach The individual is asked to describe his/her aims in a situation. What problems s/he experienced and what help s/he would like from the teacher

The SET-GO framework  describe first what was S een/experienced ( descriptive,specific )  Probe to discover what E lse was seen/ experienced  Trainee recalls his/her T houghts at the time ( reflecting back on experience)  Trainee clarifies G oals s/he would like to achieve  Explore various O ffers on how to achieve this goal

What makes for effective feedback? Make it constructive and descriptive Avoid why questions Ask what, where and how something happened Be gentle and supportive and not hitting some one on the head because of a mistake Be accurate and clear on particular behaviour Include specific suggestions for improvement Address the learners agenda

Effective feedback Constructive feedback   Helpful well intentioned   Respectful, supportive and sensitive   Appropriate to the learners wants and needs   Focused on what the learner can change   No more than the leaner wants/ can deal with   Checked with the leaner Descriptive feedback   Observation, not inference   Sharing of ideas and not giving advice   Exploring alternatives and not giving answers   Specific and not general guidance   Analysis of actions, not judging the person   Evaluation of why something does and does not work

Ende JAMA 1983;250: Guidelines for Giving feedback should be undertaken with teacher and trainee working as allies with common goals Should be well tuned and expected and not imposed Should be regulated in quantity and limited to behaviours that are remediable Should be phased in descriptive non-evaluative language Should deal with specific performance and not generalization Should offer subjective data, labelled as such Should deal with decision and actions, rather than assumed intentions Feedback :

Any evidence? Hewson and Little: Giving feedback in medical Education J Gen Intern Med 1998:13: Ende J : Feedback in clinical medical Education, JAMA 1983:250(8) Bing-You R: Medical Students Needs for feedback Teaching and learning in Medicine 1995 Vol.7 No

Hewson& Little J Gen Int Med :

Remember to celebrate When all goes well !!!!!!