feedback Transition day 2014 kcabdeef feedbak feedback

Feedback  A system by which some of the energy from the output of a communications circuit is returned to the input circuit, either to increase or reduce the power or to regulate the quality of the signal.  A sensory or perceptual report of the result of any behavior which may reinforce or modify subsequent behavior.

“Feedback is the control of a system by reinserting into the system the results of its performance. If the information which travels backwards from the performance is able to change the general method and pattern of performance, we have a process called learning. " –Jack Ende

Feedback Operant conditioning? (Type II reflexes)

What do these nice people have in common?

All are elite, expert performers

All are elite, expert performers who know that practice makes perfect

In theory there is no difference between theory and practice... -Yogi Berra

In practice, there is. -Yogi Berra

Does Shows How Knows How Knows Expert, Elite Performer NOVICE Miller GE. Academic Med Cognitive

Does Shows How Knows How Knows NOVICE Miller GE. Academic Med Skills Expert, Elite Performer

Ability Expert/Master Proficient Competent Advanced Beginner Novice Dreyfus SE, 1980 Observer Reporter Manager Instructor Interpreter ORIME

The acquisition of superior performance in medicine is closely related to engagement in practice with feedback during medical training.” -Ericcson, Academic Med 2004

If you don’t know where you’re going, you might end up someplace else. -Yogi Berra Feedback can be your GPS

Patient care: Information Management-recording & presenting Data Gathered from History and Physical Exam Presentations disorganized. Difficulty discerning amount of detail needed. Imprecise, Assessments not well defended Presentations fluent, well organized, clinically precise Able to discern relevant details while staying concise.

You can learn a lot by watching -Yogi Berra

Feedback: evaluation of performance facilitates coaching

If I’ve told you once I’ve told you a thousand times! It’s “i” before “e” except after “c”!

Medical Math Feedback = teaching

Feedback

SO WHAT PART OF MY INSTRUCTIONS DID YOU NOT UNDERSTAND?!?!? I SAID THAT’S “i” BEFORE “e” EXCEPT AFTER “c”

What would be effective feedback for you? We don’t all receive feedback in the same way. If you have received feedback that was ineffective, why was it so? If you received feedback that was effective, how was it different?

For example, The case of Millie Kablunschki

Was this feedback? “A sensory or perceptual report of the result of any behavior which may reinforce or modify subsequent behavior. “

Feedback occurs when a recipient gains insight into what they did and is instructed in its consequences and ways to improve Feedback in this case? The teacher said: 1. Student did not focus on the patient first 2. Student did not give pertinent findings 3. Student was reminded that vitals are always pertinent 4. Student was re-taught that a CXR cannot make a diagnosis 5. Student was informed about consequences

Was it effective feedback? That’s up to the receiver

Do we recognize feedback? We receive a lot of feedback every day Learn to identify it Learn to act on it Most feedback is not received in formal, “sit-down” settings It is not personal Our dress, behavior, speech, habits all affect how we perform as a professional Tone of voice, facial expression, composition can sometimes overshadow the message – tune in to the message

Effective feedback should be: 1. Delivered face to face 2. Delivered in appropriate doses 3. Delivered in a timely fashion

It’s all in the eyes

Effective feedback should be: 1. Delivered face to face 2. Delivered in appropriate doses 3. Delivered in a timely fashion

“I must talk to you about your nose hair.”

Effective feedback should also be: 1. Specific, Concrete, Objective Ask for examples. Response? “vital signs need to be in every note.” Facts are difficult to dispute, focus on work product, i.e. patient care 2. Professional – Respectful in voice, words, timing, location We are future colleagues 3. Explanatory, educational “Be sure to check the chart. As you learned from Mrs. Kablunschki there is no need to order labs that have been done recently. 4. A plan for improvement Focus on the next step in learning, improved performance, how to make our work/patient care better

Make sure it is specific  If student Nonny hears: “good job”  Nonny will assume he is doing “honors” work  If Noddy hears: “good job”  Noddy will assume she is barely keeping up  Feedback given in a stressful situation may require repetition (and medical school is stressful…)  E.g. “Remember yesterday I told you that vital signs are always pertinent so I expect you to report them on every patient.”

What to know about giving feedback Students also give feedback It needs to be: objective, timely, professional, explanatory, and a plan for improvement We need to be able to trust the feedback we receive Provider must be observant, competent and objective to provide the appropriate feedback Students must be the same

What to know about giving feedback

What to know about feedback 1. Skill development (learning) depends on getting practical and timely feedback based on direct observation. 2. We can influence quantity and quality of feedback we get. Take initiative and be prepared to invest in the beginning Identify, set and share learning goals Create opportunities for practice with observation Schedule times for feedback 3. Pick up on the positive, catch the message in any delivery 4. Tune in and respond to feedback given

You’ve got to be very careful if you don’t know where you are going, because you might not get there. -Yogi Berra

What’s the point? Keep the goal in mind – better patient care Because it isn’t about me, It is about how best to serve my patients

Excuse me for interrupting, but it’s “i” before “e” except after “c.” (Weird isn’t it?)

The ends