1. Giving feedback Tools of the Trade 21 st November University of Leicester Dr Adrian Hastings and Dr Rhona Knight

2. Feedback or knowledge of results, is the lifeblood of learning. Rowntree D (1982) Educational Technology in Curriculum Development(2e). Paul Chapman Publishing, London. Giving feedback constructively valued by junior and senior doctors Wall D and McAleer S (1999) Teaching the consultant teachers - identifying the core content. Medical education 33.

3. What will we cover? Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

4. Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

5. Why bother with feedback? It works: –improves learning outcomes –better marks in assessments –better results in other learning situations –deepens approach to learning –encourages active pursuit of understanding and application of knowledge Black P and Wiliam D (1998) Assessment and classroom teaching. Assessment in Education 5:7-73. Rolfe I and McPherson J (1995) Formative assessment: How am I doing? Lancet 385:837-9.

6. Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

7. What is it? A two-way process in which an educational supervisor or group appropriately share with the learner information based on observation, with the aim of reaching a defined goal. Knight R. The Good Consultation Guide for Nurses, Radcliffe 2006.

8. Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

9. In three groups Task 1 –Each share a time when you received feedback that was helpful –As a group draw together some key themes of helpful feedback Task 2 –Each share a time when you received feedback that was harmful –As a group draw together some key themes of harmful feedback Task 3 –Identify a list of key features of effective feedback

10. Two dimensions to feedback Challenge Support

11. Two dimensions to feedback High Challenge High support Low support Low Challenge

12. Two dimensions to feedback High Challenge High support Low support Low Challenge Good, carry on, seems to be working

13. Two dimensions to feedback High Challenge High support Low support Low Challenge In passing Nothing Unspecific Dismissive

14. Two dimensions to feedback High Challenge High support Low support Low Challenge That was great, youre obviously trying hard

15. Two dimensions to feedback High Challenge High support Low support Low Challenge Patronising General Safe

16. Two dimensions to feedback High Challenge High support Low support Low Challenge Well that could have been done better – why did you not focus more, early on..?

17. Two dimensions to feedback High Challenge High support Low support Low Challenge Critical Induces defensiveness Paralysing

18. Two dimensions to feedback High Challenge High support Low support Low Challenge A good effort. I could see how you were drawing the feelings out – I wonder if you got to the crux of the matter…?

19. High Challenge High support Low support Low Challenge Focused Attentive Threatening? Two dimensions to feedback

20. Types of feedback Brief feedback Formal feedback Major feedback

21. Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

22. A selection of tools Tool 1: Pendletons Rules Tool 2: Calgary - Cambridge Tool 3: Non-judgemental feedback Tool 4: Observation versus deduction Tool 5: Pi Tool 6: PEE Tool 7: Unacceptable behaviour

23. 1. Pendeltons rules

24. 1.Pendletons Rules (Pendleton D, Schofield T, Tate P, Havelock P. The New Consultation. Oxford University, 2004.) The learner goes first and performs the activity Questions then allowed only on points of clarification of fact The learner then says what they thought was done well The teacher then says what they thought was done well The learner then says what was not done so well, and could be improved upon The teacher then says what was not done so well and suggests ways for improvements, with discussion in a helpful and constructive manner

25. 2. Calgary – Cambridge

26. SET-GO (Silverman et al.) What I Saw What Else did you see? What does the learner Think? What Goal are we trying to achieve? Any Offers on how we should get there?

27. ALOBA (Silverman et al.) A genda L ed O utcome B ased A nalysis

28. 3. Non-judgemental feedback

29. Non-judgemental feedback –Based on description –Communication skills are neither intrinsically good nor bad, they are just helpful, or not helpful, in achieving a particular objective in a given situation –Silverman et al.

30. Descriptive non-judgmental feedback Aim: to support the learner and maximise learning

31. What is it? Evaluative/judgemental –The beginning was awful, you just seemed to ignore her. –The beginning was excellent - great stuff!! Descriptive –At the beginning you were looking at the notes, which prevented eye contact. –At the beginning you gave her your full attention and never lost eye contact – your facial expression registered your interest in what she was saying.

32. 4. Observation vs deduction

33. Observation versus deduction –Separate behaviour and interpretation –Make interpretations tentative –I noticed at this stage that you moved more in your seat, and your face became red, I wondered if you might be embarrassed?

34. I saw you look at your watch and thought you might be bored I saw him talking with his hand over his mouth and wondered if he was lying

35. Behaviour Arms folded Legs crossed Flushed cheeks Rapid voice tempo Slow steady breathing Tight lips Interpretation Bored Good rapport Embarrassed Amused Disgusted

36. 5. Pi ( ) – Point / Illustration

37. Pi ( ) – Point / Illustration –Make sure that the student knows what youre talking about! –As well as a label, give an example Point Illustration

38. Point / Illustration Point Id like you to use more open questions at the beginning of the consultation. Illustration Why not ask the patient at the beginning How can I help?

39. 6. PEE – point / explanation / example

40. 5. PEE – point / explanation / example –Id like you to clarify more what the patient said. (Point) –Clarification is about checking you understand what the patient means. The patients understanding is not always the same as yours. (Explanation) –If the patient says she is worried something might be serious, you could clarify what she means by serious. (Example)

41. Why bother with feedback? What is feedback? Key features of feedback General principles of feedback A feedback toolbox Consider the practicalities

42. In groups In what situations would you use each of these tools for feedback?

43. A selection of tools Tool 1: Pendletons Rules Tool 2: Calgary - Cambridge Tool 3: Non-judgemental feedback Tool 4: Observation versus deduction Tool 5: Pi Tool 6: PEE

44. A final tool…

45. 6. Unacceptable behaviour (eight top tips) 1. Check person is OK before you start 2. Use a wake-up, warning phrase: Theres something very serious I have to say 3. Say, very simply, what is not right 4. Give an example as appropriate

46. 5. Relax the tone to allow for a positive response usually an offer to improve ensues 6. Respond to offer positively but define specific, measurable outcomes 7. Do not be drawn into discussion on: –justification of behaviour –your right to judge

47. 8. Separate behaviour and person –Most of us take criticism better if it is not personal. Maybe what I did was not good – but it doesnt mean Im no good. Make sure that the student can see this distinction too.

48. In twos One of you is a junior colleague One of you is the tutor –Identify an area of bad behaviour you have had to deal with –Share it with your partner –It is the job of the tutor to address the bad behaviour described

49. Summary...

50. TEAM Feedback Guidelines T iming E nvironment A ppropriate M anageable

51. Appropriate feedback is: –Suited to purpose –Specific –Directed towards behaviour rather than personality –Checked with the recipient –Problem solving –A suggestion rather than prescriptive

52. Useful further reading: Teaching made easy Chambers and Wall Radcliffe 2000 ISBN: 1-85775-373-9 Teaching and learning communication skills in medicine Kurtz, Silverman and Draper Radcliffe 1998 ISBN: 1-85775-272-2 Adult and continuing education Jarvis Routledge 1995 ISBN: 0-415-10242-1 The Good Consultation Guide for Nurses Hastings and Redsell (eds) Radcliffe 2006 ISBN: 1-85775-688-6