Feedback, Part 1 Learning Skills and Techniques to Provide Meaningful Feedback Institute for Excellence in Education Summer Teaching Camp 7/25/13 Barry Solomon, MD, MPH

Thank you Small Group Leaders Meredith Atkinson Joe Cofrancesco Jules Jung Rachel Levine Leah Wolfe Janet Serwint “Fishbowl” Participants Radu Dudas Kristopher Kast Kyle Mahoney Tyler Mains Brent Pottenger Sarah Sunshine

Disclosure The speaker and group facilitators have no financial relationship with any commercial interest.

Objectives 1. To appreciate the importance of giving meaningful feedback to learners. 2. To understand potential barriers and benefits to giving feedback. 3.To learn techniques and practice giving and receiving feedback (essential elements and Ask-Tell-Ask approach)

Session Timeline 8:30-8:50 - Feedback Overview 8:50-9:05 - “Fishbowl” Exercise – Student Voices 9:10-9:45 – Feedback Practice 9:50-10:00 – Large Group Wrap Up

Rationale for Giving Feedback Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or, not at all. Jack Ende - Feedback in Clinical Medical Education. JAMA 1983;250: Good behavior is not reinforced Mistakes go Uncorrected Learner will make assumptions

Barriers Time commitment Failure to obtain first hand data and specific examples Lack of perceived value Previous negative experiences Unclear performance expectations Effects on teacher-learner relationship Lack of training

Giving Back To the learner – Provides opportunity for growth – Helps develop insight into own behavior – Allows learner to reach self-defined goals To the teacher – Provides personal fulfillment – Demonstrates interest and caring To the profession – Responsibility to our patients and colleagues – Ensures the development of competent physicians

Essential Elements of Feedback Well timed and expected Teacher and learner working together with common goals Based on first hand data Regulated in quantity Phrased in descriptive language, based on specific observed behaviors Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:

The Feedback Sandwich Praise Criticism Praise

The New Feedback Sandwich Ask Tell Ask

Ask learner to assess own performance first –Phrase question to encourage meaningful reflection What went well? What could have gone better? What were your goals? –Make sure to allow adequate time for the answer Begins a conversation Assesses learner’s level of insight Promotes self-assessment and reflective practice

Tell React to the learner’s observation – Feedback on self-assessment Tell what you observed: use specific behaviors without judgment (positive and constructive) Instead of…“It’s annoying when you are late.” Try…“I noticed you have been arriving late to rounds.” Instead of… “You need to speak up, you’re too shy.” Try… “When I asked for your input on patient management, you didn’t say anything.”

Ask (again) Ask about learner’s understanding and strategies for improvement – What could you do differently? – Again, give enough time – Give own suggestions – Consider replaying parts of the encounter: “show me” Close by committing to monitor improvement together

Small Group Practice Session Brief review of two tools –Feedback Checklist & Stepwise Approach Practice in pairs (10 minutes then switch) Choose scenario that best fits your teaching role –Clinical: Outpatient Setting Attending-Student or Attending-Resident –Clinical: Inpatient Setting Resident-Student –Non-Clinical Small Group Teaching Setting Instructor-Student –Non-Clinical: Research/Lab Setting Faculty/Fellow-Student

Small Group Practice Sessions Group 1 - Meredith/Barry, Room 370 Group 2 – Janet, Room 320 Group 3 – Leah, Room 326 Group 4 – Rachel, Room 420 Group 5 – Joe, Room 426 Group 6 – Jules, Rooms 381/382

Fishbowl

Feedback Wrap Up Lessons Learned –What went well? –What was challenging? Consider “Fishbowl” as a teaching tool Tomorrow… Feedback, Part 2 - Giving Feedback and Developing Individual Learning Plans for Struggling Learners (Laura Hanyok, MD and team)