Feedback 101 A Guide to the Fundamentals of Standardized Patient Feedback

Significance of Feedback  What is it? Information to student about how SP felt in response to what student said or did during interview  Why is it important? Enriches teaching situation Student hears how their behaviour affected patient Student has opportunity to maintain or modify behaviour

How to Recruit SPs for Feedback  Recruit SPs for emotional maturity and potential for excellent communication skills  Choose SPs who are comfortable in front of large and small groups  Screen for biases  Screen for personal agendas & ‘baggage’

At the University of Toronto…  Feedback workshops  Feedback segments included in trainings and dry runs  Stretching feedback skills through increasingly complex projects  Trusting and encouraging SPs to find and use their own unique voice/style  It’s an on-going investment

Feedback Workshops  At least twice a year – have food and make it fun  At different levels: beginners –advanced  Approx 3 hours  Small and large group learning exercises  Active learning, highly participatory  Live demonstrations, individual practice, games

Trainings and Dry Runs  When appropriate, trainers integrate feedback training into regular trainings and dry runs –Need to know learning objectives –Awareness of ethical issues of case –Clarify their needs as patients –Practice giving feedback during training to a variety of interviewing styles/approaches

Stretching Feedback Skills  Simple to complex feedback situations Basic feedback to Year I students Complex feedback to Year IV students/residents Tutoring residents in difficulty Continuing education for physicians in peril End of life issues and palliative care including family conferences Restorative justice and conflict resolution

Trusting and Encouraging SPs  Expect high standards  Provide pre-session support  Provide post session debriefing  Allow SPs the freedom to find their “own legs”, “own voice”, “own style”  Acknowledge difficulty of giving feedback  Encourage on-going development of feedback skills

Practice What You Preach  Culture of the Program is invested in the challenge of modeling exemplary communication skills and feedback skills  Emphasis is placed on demonstrating good communication skills especially when giving feedback on communication skills  This maintains credibility of Program

Main Characteristics of Feedback  Specific rather than general  Based on observable behaviour rather than inference  Descriptive rather than evaluative  Sharing information rather than giving advice  Constructive rather than destructive

Structure for Giving Feedback  Transition from interview to feedback  Opening to feedback  Body of feedback  “Checking in”  Closure  Debriefing

Transition from Interview to Feedback  After the interview is over… Take a few deep breaths Organize your thoughts Introduce yourself

Opening to Feedback  Where to begin  Ask how the student felt – this gives you an understanding of how they are feeling and a good place to start (active listening)

The Body of Feedback  The basic ‘formula’ “When you….I felt….” “I felt….when you….”  Identify how you felt and back it up with specifics  A few points are usually sufficient  ‘Sandwich’ technique

“Checking In”  Give the student the opportunity to respond to your feedback –Do you have any questions? –How are you feeling about what I said?

Closure  Thanks …For the opportunity to meet with you  Acknowledge the student’s efforts

Debriefing for the SP  Self reflection …“What have I learned?”  Release yourself …From the case…Debrief if necessary  Report to trainer …Anything unusual or unsafe  Maintain confidentiality

Tips  Substitute “and” for “but”  There’s no right or wrong – it’s a learning experience - everyone has their own unique strengths  Keep it simple  Use a professional conversational style

Tips (continued)  Avoid the following words: “should”, “could”, “ought to”, “need to”  Let’s think about alternatives:

Vocabulary – “I felt…”  Reassured  Understood  Encouraged  Relieved  Cared for  Satisfied  Hopeful  Supported  Rushed  Frustrated  Anxious  Confused  Afraid  Embarrassed  Worthless  Foolish