Medicine, Dentistry and Veterinary Medicine

Medicine, Dentistry and Veterinary Medicine Giving feedback Tools of the Trade 21 st November University of Leicester Dr Adrian Hastings and Dr Rhona Knight

What is in the handout? Why bother with feedback? What is feedback? Key features of feedback General principles of feedback –Types –Guidelines A feedback toolbox Useful pre and post course reading

Why bother with feedback?

Why bother? ‘Feedback, or knowledge of results, is the lifeblood of learning.’ Rowntree D (1982) Educational Technology in Curriculum Development (2e). Paul Chapman Publishing, London. ‘Feedback is an essential component of education and adult learning.’ Branch WT, Paranjape A. Feedback and reflection: teaching methods for clinical settings. Acad Med. 2002:77,

Why bother? It works: –improves learning outcomes –better marks in assessments –better results in other learning situations –deepens approach to learning –encourages active pursuit of understanding and application of knowledge Black P and William D (1998) Assessment and classroom teaching. Assessment in education 5:7-73. Rolfe I and McPherson J (1995) Formative assessment: How am I doing? Lancet 385:837-9.

What is it?

What is it? ‘A two-way process in which an educational supervisor or group appropriately share with the learner information based on observation, with the aim of reaching a defined goal.’ Knight R. The Good Consultation Guide for Nurses, Radcliffe 2006.

Key features of feedback

Key features? Challenge Support

General principles of feedback

Types of feedback Brief feedback Formal feedback Major feedback

TEAM Guidelines T iming E nvironment A ppropriate Manageable

A feedback toolbox

A selection of tools Tool 1: Pendleton’s ‘Rules’ Tool 2: Calgary - Cambridge Tool 3: Non-judgemental feedback Tool 4: Observation versus deduction Tool 5: Pi Tool 6: PEE Tool 7: Unacceptable behaviour

1. Pendelton’s ‘rules’

1.Pendleton’s ‘Rules’ (Pendleton D, Schofield T, Tate P, Havelock P. The New Consultation. Oxford University, 2004.) The learner goes first and performs the activity Questions then allowed only on points of clarification of fact The learner then says what they thought was done well The teacher then says what they thought was done well The learner then says what was not done so well, and could be improved upon The teacher then says what was not done so well and suggests ways for improvements, with discussion in a helpful and constructive manner

2. ‘Calgary – Cambridge’

SET-GO (Silverman et al.) What I Saw What Else did you see? What does the learner Think? What Goal are we trying to achieve? Any Offers on how we should get there?

ALOBA (Silverman et al.) A genda L ed O utcome B ased A nalysis

3. Non-judgemental feedback

Non-judgemental feedback Based on description ‘Communication skills are neither intrinsically good nor bad, they are just helpful, or not helpful, in achieving a particular objective in a given situation’ –Silverman et al

What is it? Evaluative/judgemental –The beginning was awful, you just seemed to ignore her. –The beginning was excellent - great stuff!! Descriptive –At the beginning you were looking at the notes, which prevented eye contact. –At the beginning you gave her your full attention and never lost eye contact – your facial expression registered your interest in what she was saying.

4. Observation vs deduction

Observation versus deduction Separate behaviour and interpretation Make interpretations tentative I noticed at this stage that you moved more in your seat, and your face became red, I wondered if you might be embarrassed?

5. Pi (  ) – Point / Illustration

Pi (  ) – Point / Illustration Make sure that the student knows what you’re talking about! As well as a label, give an example Point Illustration

6. PEE – point / explanation / example

PEE – point / explanation / example Make sure that the student knows what you’re talking about! As well as a label, give a reason and an example Point Explanation Example

7. Unacceptable behaviour

7. Unacceptable behaviour (West Midlands modular trainers’ course, 2003) 1. Check person is OK before you start 2. Use a wake-up, warning phrase: “There’s something very serious I have to say” 3. Say, very simply, what is not right 4. Give an example as appropriate 5. Relax the tone to allow for a positive response usually an offer to improve ensues 6. Respond to offer positively but define specific, measurable outcomes 7. Do not be drawn into discussion on –justification of behaviour –your right to judge 8. Most of us take criticism better if it is not personal. –“Maybe what I did was not good – but it doesn’t mean I’m no good.” –Make sure that the student can see this distinction too

Summary

Good feedback is Suited to purpose Specific Directed towards behaviour rather than personality Checked with the recipient Problem solving A suggestion rather than prescriptive

TEAM Guidelines T iming E nvironment A ppropriate M anageable

Useful further reading: Teaching made easy Chambers and Wall Radcliffe 2000 ISBN: Teaching and learning communication skills in medicine Kurtz, Silverman and Draper Radcliffe 1998 ISBN: Adult and continuing education Jarvis Routledge 1995 ISBN: The Good Consultation Guide for Nurses Hastings and Redsell (eds) Radcliffe 2006 ISBN:

Useful pre-course reading Ende J. Feedback in clinical medical education. JAMA. 1983:250, – Silverman J, Draper J, Kurtz SM. The Calgary – Cambridge approach to communications skills teaching 1: Agenda led outcome based analysis of the consultation. Educ Gen Prac.1996; 7, Silverman J, Draper J, Kurtz SM. The Calgary –Cambridge approach to communications skills teaching 2: SET-GO method of descriptive feedback. Educ Gen Prac.1996; 8, 16-23