Objectives understand the feedback process and its’ importance to learning understand the feedback process and its’ importance to learning know factors inhibiting effective feedback know factors inhibiting effective feedback know the principles of delivering effective feedback know the principles of delivering effective feedback practice giving constructive feedback practice giving constructive feedback exchange ideas regarding feedback exchange ideas regarding feedback

Why important? promote learning promote learning facilitate improvement facilitate improvement without feedback without feedback mistake go uncorrected mistake go uncorrected good performance not reinforced good performance not reinforced clinical competence by trial and error clinical competence by trial and error student develop sense of uncertainty | arrogant student develop sense of uncertainty | arrogant

Why important? create positive learning environment create positive learning environment support LLL skill support LLL skill self reflection self reflection self analysis self analysis facilitate summative evaluation facilitate summative evaluation central to effective teaching & teacher central to effective teaching & teacher learners love it! learners love it!

Why worried? absent of observation absent of observation absent of feedback absent of feedback inconsistency inconsistency reluctant to give negative feedback reluctant to give negative feedback giving feedback is a trainable skill giving feedback is a trainable skill structured feedback is better than traditional feedback structured feedback is better than traditional feedback

Feedback in General first in rocket engineering, 1940s first in rocket engineering, 1940s Feedback is the control of the system by reinserting into the system the result of its performance. Feedback is the control of the system by reinserting into the system the result of its performance. If feedback change the general method and pattern of the performance for better outcome, the whole process can be called ‘learning’. If feedback change the general method and pattern of the performance for better outcome, the whole process can be called ‘learning’. Either positive or negative feedback can be constructive. Either positive or negative feedback can be constructive.

Pitfalls of Giving Feedback inadequate data inadequate data observation is a must observation is a must unclear expectation unclear expectation shared goal and objectives shared goal and objectives equating teaching and discussion with feedback equating teaching and discussion with feedback difficulty in talking about weaknesses difficulty in talking about weaknesses time and timing time and timing

Uhmm…. Teachers’ Myths “They know how they are doing.” “They know how they are doing.” “Is this an anomaly?” “Is this an anomaly?” “I don’t have time.” “I don’t have time.” “This is awkward!” “This is awkward!”

What to give feedback? predominantly Skill predominantly Skill clinical skill clinical skill  Hx taking, physical examination  decision making  procedural skill communication skill communication skill  to discussion group  to patient  to medical team

No surprise! No surprise! inform them: When? Where? and How? inform them: When? Where? and How? start with ‘learners’ self-feedback start with ‘learners’ self-feedback How did you think…? How did you think…? timing and timely timing and timely daily routine daily routine close to the event close to the event Giving Feedback Guideline

focus on the task / skill / observable behavior focus on the task / skill / observable behavior avoid reference to personality avoid reference to personality avoid reference student intention avoid reference student intention avoid generalization avoid generalization avoid terms conveying personal emotion avoid terms conveying personal emotion refer to behavior that can be changed refer to behavior that can be changed

non-judgmental terms are most effective non-judgmental terms are most effective action, not interpretation action, not interpretation descriptive, not evaluative descriptive, not evaluative subjective data is OK sometimes subjective data is OK sometimes Giving Feedback Guideline

Avoid judgmental terms Avoid judgmental terms create negative learning climate create negative learning climate alienate the student alienate the student create an conflicting relationship create an conflicting relationship Giving Feedback Guideline

Scenario Judgmental VS non-judgmental เธอนี่ช่างไม่ เห็นแก่จิตใจ คนไข้เลย เธอ คิดว่าคนไข้ ไม่ใช่คนหรือ ยังไง ! เธอนี่ช่างไม่ เห็นแก่จิตใจ คนไข้เลย เธอ คิดว่าคนไข้ ไม่ใช่คนหรือ ยังไง !

be clear and specific be clear and specific avoid generalization avoid generalization Giving Feedback Guideline

Vague VS Specific การตรวจ ร่างกายเธอยัง ไม่ดีเท่าไหร่ ไปฝึกมาให้ ดีกว่านี้ ! การตรวจ ร่างกายเธอยัง ไม่ดีเท่าไหร่ ไปฝึกมาให้ ดีกว่านี้ ! Scenario

identify an approach to promote improvement - the action plan identify an approach to promote improvement - the action plan provide example provide example Giving Feedback Guideline

Poor Feedback emotional emotional anger anger defensiveness defensiveness embarrassment embarrassment no improvement no improvement

FAST Feedback F requent F requent A ccurate A ccurate S pecific S pecific T imely T imely

Sequel train learner to receive and use feedback train learner to receive and use feedback have them summarize feedback and plan have them summarize feedback and plan feedback the feedback feedback the feedback peer assessment and peer feedback peer assessment and peer feedback train them how to give feedback train them how to give feedback checklist is OK, but not always checklist is OK, but not always passing the exam unequal getting feedback passing the exam unequal getting feedback

IMPROVE by Feedback I - Identify objectives with the learners I - Identify objectives with the learners M - Make a friendly environment M - Make a friendly environment P - assess Performance P - assess Performance R - Respond to learners’ self assessment R - Respond to learners’ self assessment O - be Objective O - be Objective V - Validate what has been done well V - Validate what has been done well E - Establish a plan to implement change E - Establish a plan to implement change