The Evaluation & Feedback of your Medical Student Instructor Name

Goal Residents will improve their feedback techniques to heighten the students learning experiences in the clinical setting.

Objectives At the end of the session, the learner will be able to: Define feedback and describe its importance Distinguish between formative & summative feedback Distinguish between feedback & evaluation Describe the characteristics of feedback Identify barriers to giving feedback

What is Feedback? “Feedback is when a learner is offered insight into what he or she actually did, as well as the consequences of his or her actions. Feedback highlights the dissonance between the intended result and the actual result, thereby providing impetus for change.” J. Ende Feedback in clinical medical education. JAMA 250(6): , 1983 Aug 12.

Why is it important? Students who receive regular feedback Perform significantly better Develop better judgment Learn faster 0ne of the most important qualities of a good preceptor

Without Feedback Mistakes go uncorrected Good performance is not reinforced Clinical competence is not achieved Learners self-validate

Formative Vs. Summative Feedback can be both Formative informs the learner w/ ongoing feedback Giving throughout the rotation Allows learner the opportunity to correct Summative verifies attainment of competency Given at the end of rotation No present opportunity to correct

Feedback Vs. Evaluation Feedback Presents information Formative i.e., guides learner to goal Neutral i.e., verbs & nouns Evaluation Presents a judgment Typically summative i.e., how well learner met goal Normative statements i.e., adverbs & adjectives

Feedback Vs. Evaluation FeedbackEvaluation TimingTimelyScheduled SettingInformalFormal BasisObservation ContentObjective ScopeSpecific Action Global Performance PurposeImprovement“Grading”

Case 1: What would you do? You realize the morning after being on call that your intern did not appropriately evaluate a patient with ______. Therefore, the patient was not given ____ and showed signs of significant _____. What do you say to the intern? (both immediately and later)

Essential Characteristics of Feedback Descriptive, not judgmental Specific, not general Focus on changeable behaviors Emphasize consequences Be Timely Based on first-hand information (not hearsay)

Judgmental (not specific) “You guys are awful. I’m tired of watching you guys screw up. Try harder and win. I expect 3 TDs in the second half! Just do it! I don’t want to lose my job.”

Specific (not judgmental) “We’re getting killed on the blitz. The offensive line needs to focus on #40 better. JPW, drop back…” Specific things to improve

Changeable Behavior Provide feedback on performance discrepancies that are within the control of the learner Consider current skills / knowledge for learner’s level

Emphasize Consequences Provide (or ask learner to provide) possible outcomes if the behavior is not changed Highlight the benefits to changing the behavior

Be Timely w/ Feedback Ensures more accurate recall Immediate feedback is more believable Allows learner to modify behavior earlier versus letting it continue (making it more difficult to correct)

Based on Firsthand Information Observe the student You cannot provide feedback on Skills you haven’t observed Knowledge you haven’t questioned Reasoning you haven’t heard Attitudes you haven’t experienced

Giving Feedback Describe the performance Wait for learners comments May provide you insight into the problem Recommend how to improve Be specific and be clear Coach, not judge

Example: Student Too Slow Instead of “You took way too long interviewing that patient. You need to be out of the room in about 20 minutes with your H&P.” Say “I noticed you were in Mrs. Smith’s room for an hour.” Then wait

Example: Student Too Slow Student replies “I know, I just couldn’t get the patient to stop talking!” “I didn’t know which questions were most important to ask” “I spent 40 minutes doing the physical exam” Recommend how to improve

Example: Student Mistake Instead of “You wanted to give the patient the wrong antibiotic for their pneumonia” Say “Why did you want to give the patient Keflex for their pneumonia?” Then wait

Example: Student Mistake Student replies “You mean Keflex isn’t a good antibiotic for pneumonia?” “oops, I meant to click on ceftriaxone instead.” “Dr. Attending said to put them on Keflex. I thought it was a bad idea.”

Example: Student Mistake Recommend how to improve Read the IDSA’s recommendations for CAP. You can find them… Computer order entry can be dangerous if you don’t pay close attention to what you are ordering… I’ll clarify this with Dr. Attending

Example: Disorganized Student Presentation Instead of: “You need to improve your presentation.” (not specific) Say: “This morning on rounds, your presentation was very disorganized. It was difficult to follow your thought process.” Wait – student can tell you what the problem was from their standpoint

Example: Disorganized Student Presentation Recommend how to improve “When you have a complicated patient, organize your presentation with a problem list. That way others can follow your thought process and your presentations will be more concise and organized.” “Also, on rounds, listen to how the stellar interns present and try to model your presentations like theirs.”

Barriers to Giving Feedback “They know how they’re doing.” “Is this an anomaly?” “I don’t have time.” The Awkwardness

Summary Effective feedback is essential to both learning & good teaching Learners who receive useful feedback perform better Without feedback, mistakes go uncorrected Feedback is a skill and can be learned & improved upon

Questions???