1. The Effect of Positive and Negative Verbal Feedback on Surgical Skills Performance and Motivation Aarthy Kannappan, MD Dana Yip, MD Nayna Lodhia, BS John Morton, MD James Lau, MD, FACS Stanford Department of General Surgery

2. Characteristics of Good Feedback Timely Timely Specific Specific Given in small quantities Given in small quantities Non-evaluative Non-evaluative Non-judgmental Non-judgmental Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81

3. Verbal Feedback in Surgery Prevalent surgical culture prone to negative and evaluative feedback Prevalent surgical culture prone to negative and evaluative feedback “Constructive criticism” thought to be the best way to improve skills performance * “Constructive criticism” thought to be the best way to improve skills performance * Affects of feedback on teacher-learner relationships, and learner motivation to study and practice not well studied Affects of feedback on teacher-learner relationships, and learner motivation to study and practice not well studied * * Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A randomized controlled trial. Med Educ. 2006 Aug;40(8):746-9.

4. Study Questions How do positive and negative verbal feedback affect immediate skills performance? How do positive and negative verbal feedback affect immediate skills performance? What is the effect of such feedback on the teacher- learner relationship? What is the effect of such feedback on the teacher- learner relationship? What is the effect of such feedback on the trainee's motivation to learn and engage in skills practice? What is the effect of such feedback on the trainee's motivation to learn and engage in skills practice?

5. Study Specifics 25 1 st year medical students with little to no laparoscopic experience Negative Verbal Feedback (n=13) Positive Verbal Feedback (n=12) Repeat FLS peg-transfer task. Survey Administered Perform FLS peg- transfer. Debrief

6. Skills Performance Results

7. Interpreting Results No significant difference in skills performance (time and number of errors) No significant difference in skills performance (time and number of errors) Could be due to non-specific nature of the feedback Could be due to non-specific nature of the feedback Most feedback in surgery is non-specific, learners unclear how to improve Most feedback in surgery is non-specific, learners unclear how to improve

8. Survey Results

9. Interpreting Results Teacher- Learner Relationship Teacher- Learner Relationship Positive feedback from a mentor: relationship with that individual would improve either somewhat (28%) or greatly (68%) Positive feedback from a mentor: relationship with that individual would improve either somewhat (28%) or greatly (68%) Negative Feedback from a mentor: relationship with that individual would deteriorate either somewhat (28%) or greatly (72%). Negative Feedback from a mentor: relationship with that individual would deteriorate either somewhat (28%) or greatly (72%). Individuals learn best from physicians they wish to emulate* Individuals learn best from physicians they wish to emulate* * *Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5 Survey Answer Responses to Positive Feedback Question (n=25) Response to Negative Feedback Question (n=25) Relationship Deteriorate Greatly0 (0%)18 (72%) Deteriorate somewhat0 (0%)7 (28%) Stay the same1 (4%)0 (0%) Improve somewhat7 (28%)0 (0%) Improve greatly17 (68%)0 (0%)

10. Interpreting Results Motivation to Learn Motivation to Learn Positive Feedback: either somewhat more (44%) or much more (52%) inclined to learn about the subject. None reported a decrease in interest in the subject. Positive Feedback: either somewhat more (44%) or much more (52%) inclined to learn about the subject. None reported a decrease in interest in the subject. Negative Feedback: one-third would be either less inclined (24%) or much less inclined (8%) to learn. Ten (40%) reported no change in their level of interest, while the rest would be either somewhat more inclined (20%) or much more inclined (8%) Negative Feedback: one-third would be either less inclined (24%) or much less inclined (8%) to learn. Ten (40%) reported no change in their level of interest, while the rest would be either somewhat more inclined (20%) or much more inclined (8%) Inclination to Learn Responses to Positive Feedback Question (n=25) Response to Negative Feedback Question (n=25) Much less inclined0 (0%)2 (8%) Somewhat less inclined0 (0%)6 (24%) No change1 (4%)10 (40%) Somewhat more inclined11 (44%)5 (20%) Much more inclined13 (52%)2 (8%)

11. Interpreting Results Motivation to Practice: Motivation to Practice: Positive Feedback: most would spend somewhat more (60%) or much more (12%) time practicing, some reported no change in (24%) or less (4%) practice time. Positive Feedback: most would spend somewhat more (60%) or much more (12%) time practicing, some reported no change in (24%) or less (4%) practice time. Negative Feedback: few would practice less (12%) or the same (16%); most would spend either somewhat more (36%) or much more (36%) time practicing. Negative Feedback: few would practice less (12%) or the same (16%); most would spend either somewhat more (36%) or much more (36%) time practicing. Inclination to Practice Responses to Positive Feedback Question (n=25) Response to Negative Feedback Question (n=25) Much less inclined0 (0%)2 (8%) Somewhat less inclined1 (4%) No change6 (24%)4 (16%) Somewhat more inclined15 (60%)9 (36%) Much more inclined3 (12%)9 (36%)

12. Conclusions Survey results only a pilot- need more longitudinal study to determine veracity of results Survey results only a pilot- need more longitudinal study to determine veracity of results Unclear relationship of of verbal feedback to skills performance Unclear relationship of of verbal feedback to skills performance The subtle affects of verbal feedback on motivation to learn and practice need to be further researched The subtle affects of verbal feedback on motivation to learn and practice need to be further researched

13. References Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A randomized controlled trial. Med Educ. 2006 Aug;40(8):746-9. Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81. Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5. Branch WT Jr, Paranjape A. Feedback and reflections: teaching methods for clinical settings. Acad Med 2002:77(12.1):4 Sheehan TJ. Feedback: giving and receiving. J Med Educ. 1984; 59:913. Isaacson JH, Posk LK, Litaker DG, Halperin AK. Resident perception of the evaluation process. Society of General Internal Medicine. J Gen Intern Med 1995:10(Suppl): 89 Kogan JR, Confroti LN, Bernabeo EC, et al. Faculty staff perceptions of feedback to residents after direct observations of clinical skills. Med Educ, 2012 Feb; 46 (2): 201-15 Papousek I, Paechter M, Lackner HK. Delayed psychophysiological recovery after self-concept-inconsistent negative performance feedback. Int J Psychophysiol.2011 Dec; 82(3):275-82. Bienstock JL, Katz NT, Cox SM, et al. To the point: medical education reviews—providing feedback. Am J Obstet Gynecol. 2007 Jun;196(6) 508-13. Fundamentals of Laparoscopic Surgery Curriculum. http://www.flsprogram.org/