1. Garry Sigman, M.D. Associate Professor, Pediatrics Chairman Student Progress Committee SSOM F EEDBACK AND R EMEDIATION

2. D EFINITIONS  Feedback: “An informed, non-evaluative, objective appraisal of performance intended to improve skills” Ende, 1983  Remediation 1. (Medicine) affording a remedy; curative 2. (Social Science / Education) denoting or relating to special teaching, teaching methods, or material for backward and slow learners remedial education

3.  Feedback: Micro-remediations- frequent, short encounters with students  Remediation: Methods of correcting problems in students who are performing poorly

4. M ODERN M EDICAL T RAINING AFTER H AUER, 2010 Feedback Experience Feedback Experience Clinical Training Assessment of Competence Remediation Advance to next level

5. T HE F EEDBACK S ANDWICH  Positive complement  Constructive criticism  Positive complement

6. P ENDLETON ’ S ‘R ULES ’  The learner goes first and performs the activity  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

7. P ROPER AND IMPROPER T ECHNIQUES FOR P ROVIDING F EEDBACK ProperImproper Based on direct observationBased on hearsay Respectful and supportiveDisrespectful, antagonistic SensitiveInsensitive Non-judgmentalJudgmental Focus on behaviorFocus on personality Focus on specificsFocus on generalities Goal-basedNot goal-based Thoughts and feelings of learner sought Not sought or considered Suggestions for improvementNo suggestions for improvement After Hewson, Little, 1998

8. P ROBLEMS WITH TRADITIONAL FEEDBACK  Imbedded in hierarchical endeavors of health professionals; educator driven one-way analysis  Reductionist  Formulaic nature is easy to become banal and unbelieved  Does not incorporate psychosocial characteristics of learners

9. P ROBLEMS WITH TRADITIONAL FEEDBACK  Traditional sandwich method- as soon as learner hears praise waits for criticism  Difficult to maintain positive emotional state  “Incompetency attacks”: negative emotional states can dominate interchange and can linger

10. L EARNER ISSUES WITH F EEDBACK  Self-assessment is not strongly validated; behavior and performance informed by unconscious mind focused on self-preservation  Recipients of negative feedback blame external factors and reject personal responsibility  Learners with high emotional stability, high levels of responsibility, and high sociability more likely to be motivated by feedback  Sargeant, 2006- in intervention group, those who received negative feedback often responded negatively, and behaved as if feedback to be obstructive to change  Poor feedback cause learner to believe that it was useless, burdensome, critical or controlling.

11. T HE N ET G ENERATION - C HARACTERISTICS  Freedom  Customization  Scrutiny  Integrity  Collaboration  Acceptance  Entertainment  Speed  Innovation  Expression

12. A GENDA LED - O UTCOMES BASED A NALYSIS ALOBA  Example:  Start with trainee’s agenda  Look at short term outcome  Encourage self-assessment and problem solving  Suggest alternatives  No negative feedback statements; make overall positive comment about performance

13. R EMEDIATION  Implies remedy  Remedy implies diagnosis  Diagnosis is best self-discovered

14. U TILIZING A MOTIVATIONAL INTERVIEWING APPROACH TO MACRO -R EMEDIATION FRAMES  F- Feedback (From course, clerkship Grade and Summation)  R- Responsibility  A- Advice (from self- Reflection)  M- Menu of options  E- Empathy  S- Self-efficacy

15. M ODEL OF R EMEDIATION P ROGRAM Mentoring Coaching Mulitimodal assessment Diagnosis of deficiency Develop individualized plan for learning Instruction, practice, feedback, reflection Reassessment Hauer, et al, 2009

16. R EMEDIATION BASED UPON DEFICITS  Knowledge deficits  Knowledge and skills deficits  Professionalism/ interpersonal deficits  Help build knowledge base  Above and practice with feedback  Feedback, instruction, reflection, observation and interaction

17. R EMEDIATION IN MEDICAL EDUCATION  Little evidence for best practices  Small number of studies indicate:  Multi-assessment tools  Individualized instruction  Practice-feedback-reflection- reassment

18. Bibliography: Feedback and Remediation Archer J. State of the science in health professional education: effective feedback. Med Educ 2010:14:101-108. Ende J. "Feedback in clinical medical education.” JAMA 1983;250:777-781 Hauer KE, et al. Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature. Acad Med 2009;1822-1832. Hewson M, Little M. Giving feedback in medical education. J Gen Intern Med 1998;13:111-116. Turner T, Palazzi D, Ward M. The Clinical Educator’s Handbook. Ch. 17. Baylor College of Medicine: 201-212.