1. Giving Feedback: Dr. A. M. Kadri Professor Community Medicine dept.
PDU Govt. medical college,
Rajkot

2. Objectives Describe rationale for giving feedback in medical education
Describe rationale for giving feedback in medical education
Identify types of feedback
Describe principles and strategies for giving constructive feedback
Define characteristics of effective feedback
Observe and practice giving feedback
Discuss common problems in giving effective feedback
To review the distinction between “feedback” and “evaluation”
So how do we give good feedback.
After my talk today, I hope ou will come away with an undderatdnign of what defines effective feedback, as well as an action plan for improving feedback in your own practice.
We’ll discuss the barriers and rational for giving feedb and you ‘ll have an oprtunity to observe, crtiqque and even practice this skill. We’ll end with a brief video clip.

3. Questions for Discussion
Why we should give Feedback?
What is feedback?
What is the role of feedback in teaching and evaluation?
Why do we avoid giving feedback?
What characterizes effective feedback?
What problems do we commonly encounter?
How can we improve feedback in our training programs?

4. Why we should give feedback?
Why we should give feedback?

5. Rationale for Giving Feedback
Without feedback,
Good performance is not reinforced,
Mistakes go uncorrected,
Competence is achieved empirically or, not at all.
Jack Ende - the father of feedback in medical education -wrote this often-referred-to JAMA article on feedback in 1983.
Without feedback, our learners may not know how they are doing, if they are doing well, or if there are elements of their performance that need to be improved so that they can be competent.
Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:

6. More Rationale High stakes outcomes It is our responsibility
High stakes outcomes
It is our responsibility
It will help learners improve their performance
Can enhance the learner teacher relationships
GO OVER OTHER POINTS QUICKLY, OR MERELY REFER TO OTHER BARRIERS AND LET PARTICIPANTS REVIEW
If students are not corrected on misinfromation and reinfroced for correct information/skills, they can’t learn
Learners need to accurately appraise their level of competence.

7. Definition
What is Feedback?

8. Feedback
Communication to another person which gives information about how he/she affects and is perceived by others.
A way of helping another person consider changing his/her behavior.

9. Feedback
Communication to another person which gives information about how he/she affects and is perceived by others.
A way of helping another person consider changing his/her behavior.

10. Feedback Provides information Based on observations Descriptive
Immediate
“Formative”
Faculty Development Office
Faculty of Medicine
©2001

11. Reinforcement/ Minimal Feedback
Statement expressing positive (or negative) reaction to a behavior which aims to increase (or decrease) the likelihood of that behavior happening again
“That was a great presentation”
“You need to work on your presentation skills”
“Reinforcement or minimal feedback” has a value judgment - positive or negative, but it doesn’t provide the information necessary to get our rocket back on course.

12. Evaluation
Qualitative judgment which ranks a learner’s performance in comparison to other learners
Often the only measure of performance visible to the learner
Usually given after the performance is over
“Evaluation” is more summative, given when the learner does not have an opportunity to demonstrate improvement to the person evaluating them at that time.

13. Evaluation Provide judgment Involves several methods
Evaluation (on a scale)
Delayed
“Summative”

14. Feedback (Reinforcement or correction) + Explanation
Keeps recipient on course to meet goals
Allows recipient to adjust your course to meet goals
Given immediately after the performance or at some time soon after, when the learner still has time to demonstrate improvement
[Review each bullet with group]

15. BARRIERS

16. It is not a part of our culture…
Although feedback is a part of many other professional cultures - including sports, dance, theatre - in which a certain performance is required, excellence is rewarded and teachers (caoshes or directors) help you attain that performance. It is not really a part of our culture
We certainly have the reinforcement and the evaluation but what of feedback?
The literature shows that our learners want it but feel that they generally do not get it.
“What feedback? No one ever gives me feedback”.

17. Why is Feedback often Avoided/Neglected?

18. Barriers It is uncomfortable Avoid confrontation
It is uncomfortable
Avoid confrontation
Learner will not be receptive
No one ever gave me feedback
Not quite sure how to do it
I hated getting feedback
Let’s first define them.
I’ll address some now and some in a little more detail later.
Not gigng feedback at the time you see it is compliit agreement with it. I.
Maybe this medical student doesn’t really need to know how to do a good abdominal exam yet.
And the number one survey say, rreason for not giging feedback is that there is not enough time.
would argue that it is a time save in the long run and in the short run it donesn’t take that much time

19. Three types of feedback in medical education
Brief feedback minutes
On a clinical skill
Formal feedback minutes
On a presentation, involves a dialogue
Major feedback minutes
Scheduled mid-point through a learning experience
Branch article
We should be much more liberal with brief and begin to work on incoprportat more fomal feedback into our teaching
Make a conscious effort to plan for and give major feedback.
Branch J, Paranjape A. Feedback and Reflection: Teaching Methods for Clinical
Settings. Academic Medicine. 2002;77:

20. What are the Essential Components of Feedback?
What are the Essential Components of Feedback?
What was done well
What could be done better
What could be done to improve next time
ther is reinforcing feedback….
There is corrective feedback…
And most importatntly a plan for future success.

21. What Makes Effective Feedback?

22. Elements of Constructive Feedback
Make sure that your feedback is:
Timely and expected
Based on observations
Based on changeable behaviors
Related to learning goals
Limited in quantity

23. The Old Feedback Sandwich
Praise
Criticism
Is it more palatable?
The problem here is that it really become s junk food.
The probme is that our learners are not involved in this sanwich delivery , we’re treatign them like a non thinking, rocket.

24. The New Feedback Sandwich*
Ask
Tell
An alternative is a different sandwich the orgins of which lie in the communication skills literature - ask-tell-ask is a model for givng patient information.
This feedback sandwich is easier to swallow because it involves a dialogue between patient—as well as between teacher and learner.
Adaptation of “The New Feedback Sandwich,’ common in patient-physician communication literature; adapted by Lyuba Konopasek, MD, for use in feedback settings.

25. In Closing Keep personal needs and feelings out Monitor your reactions
Do not overload
Time your feedback appropriately
Teach self-critique

26. Criteria for Effective Feedback
In general, feedback should be: Specific not General Immediate not Delayed Behavioral not Inferential Descriptive not Evaluative More or less not Either – Or Asked for not Pushed Upon

27. There is no single recipe for success.
Faculty Development Office
Faculty of Medicine
©2001

28. Feedback should be given in a way that the receiver can hear it, understand it, and choose to use or not use it.

29. Now It’s Your Turn!