1. Providing Effective Feedback Faculty Professional Development Series University of Pennsylvania School of Medicine October 2004 Jennifer R. Kogan, M.D. Lisa M. Bellini, M.D. Department of Medicine

2. Workshop Objectives Distinguish between evaluation and feedback Discuss principles of effective feedback Identify barriers to feedback Identify strategies to increase feedback and improve skills delivering feedback

3. Feedback vs. Evaluation

4. Feedback Conveys information Formative Current performance Neutral (verbs & nouns) Foster learning Evaluation Conveys judgment Summative Past performance Normative statements (adjectives and adverbs) Certification

5. Benefits of Feedback Assist learners to: –evaluate knowledge, practice skills –define teachers’ expectations –identify strengths/weaknesses without academic penalty –remedy deficiencies Assist teachers to: –evaluate and modify coursework and teaching –recognize student progress and achievement

6. Clinical Education Without Feedback Missed learning opportunities Student insecurity about abilities Inaccurate perception of performance Disappointment and surprise with final evaluations

7. Principles of Effective Feedback

8. Principles of Effective Feedback Related to agreed upon goals Specific Reinforce positive outcomes and behaviors Provide guidelines for improvement Regulated in quantity, limited to remediable behaviors First hand, objective information Timely Descriptive not evaluative language Accompanied by explanations Include an action plan Ende J. JAMA. 1983; 250: 777-781

9. “Feedback during clinical rotations appears to be a rather intractable problem in medical education” Irby DM. Acad Med 1994; 69:333-42

10. What Are The Barriers To Feedback?

11. What Are Barriers to Feedback? Time constraints Limited information about learner performance Absence of standards of competence Inadequate knowledge of tenets of effective feedback Giving constructive feedback Concern about undesirable consequences for student or teacher

12. Structured Approach to Deliver Feedback

13. Set the Stage  Create environment conducive to feedback  Elicit learner’s goals beginning of rotation  Establish expectation of continuous feedback  Start session by telling learner: “ this is your feedback”

14. Conduct the Feedback Session  Elicit learner’s self-assessment - what was done well - what needs improvement  Provide feedback: positive and negative  Check for understanding  Develop action plan/ determine how to monitor progress

15. Follow-Up  Meet again  Ensure action plan developed/in progress

16. The Feedback Sandwich

17. Feedback Role Plays

18. What Tools Can You Implement to Increase Feedback?

19. Feedback Toolbox Mid rotation feedback forms Read/distribute feedback article Mini-CEX or encounter cards Learner’s contract Prime learners for feedback –review tenets of feedback at orientation –prompt students during course –teach students how to ask for it