1. Five Microskills of Effective Feedback Focus on SBIRT Maureen Strohm, MD, MSEd with thanks to Julie G Nyquist, Ph.D.

2. Afternoon Objectives
By the end of the session participants should be better able to:
Teach in relation to SBIRT
Utilize the 5 Microskills during Clinical Teaching encounters
Provide effective feedback to family medicine residents in an office-based setting

3. Elements of All Behaviors
Knowledge
Skill
Behavior
Environment
Attitude
(confidence, willingness)

4. Teaching/Learning Techniques Outpatient Clinical Settings
Role modeling
One-to-one precepting
Observation & feedback
Case presentation & feedback
Direct Patient Contact

5. Clinical Teaching Three basic phases:
Planning and preparing for instruction
Implementing instruction
Evaluating learner outcomes

6. Clinical Teaching - Basic Principles
Establish positive learning environment
Establish rapport - as with patients
Communicate expectations (2-way)
Assess learner readiness and motivation
Collaborate with learners - keep the teaching/learning process learner-centered
Provide feedback and formally evaluate

7. Using the Five Microskills for Formative Feedback
Step 1. Get a commitment - Motivate the learner
Step 2. Probe for Supporting Evidence
Step 3. Teach general rules – eg., DEATH, SOBER
Step 4. Reinforce positives
Step 5. Correct mistakes … following self-critique
John Neher, 1992 – model for clinical teaching within time constraints: Precepting provides opportunities to teach “ways of thinking” as well as info. Recognizes “teachable moments”

8. Step 1. Get a commitment
What do you think is going on with this patient?
What would you like to do?
Even a hunch or a guess is better learning than no commitment

9. Step 2. Probe for Supporting Evidence
What led you to that diagnosis?
Why did you choose that drug?
Helps teacher identify what the learner does … and does not know
Must not be unpleasant

10. Teach general rules
DEATH
SOBER

11. Step 4. Reinforce positives
Reinforce what was done right
Must reward specific competencies observed
Forms basis of the “sandwich”

12. Step 5. Correct mistakes Elicit self-critique first
Best done in private
Be SPECIFIC about behaviors observed & behaviors desired (“meat” of sandwich)
Empower learner – work together to develop a concrete plan for growth

13. Providing Verbal Feedback MI Hints
Seek first to understand
Resist the urge to immediately correct
Listen to your learner
Empower your learner

14. Teaching Demonstration Steve
Learner’s interview with patient (video)
Focus on key elements of SBIRT
Learner’s use of MI
Modeling of feedback
Watch feedback process
Watch for preceptor’s use of MI
Monitor performance via Microskills checklist

15. Group Role Play Video Trigger
Starts with video interview with patient
All small group members are collectively “The Preceptor”
Use progressive interview technique
One person starts as The Preceptor
Time out when have a Q or time to move on
Only the facilitator and The Preceptor (of the moment) can call a time out/time in
During time out - learner is “asleep”
Done – discuss the process and observations

16. Questions and Answers

17. Take Home Messages Use SBIRT in your care of patients
Model MI with patients and learners
Utilize the Five Microskills with learners
Encourage learners to use MI and SBIRT
Collaborative teaching is similar to MI
Collaborative, Empathic, Respectful
Limited by learner readiness