1. Feedback & Evaluation: Quick Tips for Clinical Preceptors (Part 2) Shirley Schlessinger, MD, FACP Associate Dean for Graduate Medical Education University of Mississippi Medical Center

2. Importance of Feedback “The important things to remember about feedback in medical education are that (1) it is necessary, (2) it is valuable, (3) after a bit of practice and planning, it is not as difficult as one might think!” Jack Ende, MD JAMA, 1983

3. Formative –vs- Summative Evaluation  Formative evaluation is “coaching” and guiding  Formative evaluation INCLUDES informal, regular (daily) feedback  Mid-month formative evaluation can assure RECOGNITION of feedback by learner  Summative evaluation is “judging” or grading…

4. Errors in Evaluation  Leniency Error- tendency to give all students “good” scores  Severity Error- tendency to give all students “low” scores  Range Restriction- scoring all competency domains the same  “Halo” / “Horn” Error-ratings based on reputation of trainee  First Impression Error- failure to give feedback and opportunity to improve  Friendship bias

5. Learners in Difficulty  True knowledge, skills, attitudes deficiencies ???  Environmental confounding factors? –New baby –Divorce –Depression –Physical / Mental illness –Drugs or alcohol –Learning Disability  Always Notify the Program Director!!!!

6. Learner Dissatisfaction / Disagreement with Feedback  Not all learners will react well to constructive criticism (negative feedback!)  Similar to “Breaking Bad News” to patients  Acknowledge learner’s emotion (disappointment, frustration, anger, denial, etc…)  Focus on behavior (limited number of issues!)  Outline opportunities for improvement  Emphasize professional responsibility to be the best physician they can be!

7. The INSIGHT Model  Inquiry  Needs  Specific Feedback  Interchange  Goals  Help  Timing of Follow- up session Compare to: Ask… (self-eval) Tell… Ask… (action plan)

8. Inquiry  How does the learner think things are going?  Listen to the learner’s need in detail –Listening attentively and thoroughly before commenting may be all you need to do, especially for minor / temporary problems…

9. Needs  What does the learner feel he/she needs during this rotation?  Ask the learner to define personal educational goals  Learners accept feedback better when they feel the teacher has first understood their perspective…

10. Specific Feedback  Give your constructive feedback as specifically as you can  Start with positive feedback  The more concrete and behavior focused the feedback, the better it will go  Limit to just two or three key issues  Verify the learner’s understanding of the feedback you’ve given

11. Interchange  Give the learner time to respond to your feedback  Discuss learner’s role in the team  Ask the learner to brain-storm with you ways the team can work better  Work together to identify innovative ways to enhance the learning experience

12. Goals  Review existing goals for the rotation  Ask the learner to state new goals,  Reinforce any new goals you’ve just reached together  Verify that you both understand and agree on these goals

13. Help  Does the learner have any serious problems that merit a “learning consultation”? –Chief Resident –Attending Physician –Program Director / Service Chief –Learning Specialist –Student / Employee Health –Human Resources –Other????

14. Timing of Follow-up session  Any final questions or comment???  When would you and the learner like to meet again to go over how things are going?

15. Be Prepared Be Prepared  You will be a better “coach” if you have prepared adequately to give your learners feedback –OBSERVE them!!! –Critically consider their performance –Identify ways they can provide better patient care –Think “Life long learning” skills

16. And Finally…  Don’t forget you have learners at many different levels on your clinical teams  ALL need feedback / evaluation  Be familiar with the institutional expectations of each level of learner  Tailor feedback to their levels as learners, and their specific needs!