Aarthy Kannappan, MD Dana Yip, MD Nayna Lodhia , BS John Morton, MD James Lau, MD, FACS

The Effect of Positive and Negative Verbal Feedback on

Surgical Skills Performance and Motivation

Aarthy Kannappan, MDDana Yip, MD

Nayna Lodhia, BS

John Morton, MD

James Lau, MD, FACS

Stanford Department of General Surgery

Characteristics of Good Feedback

• Timely

• Specific

• Given in small quantities

• Non-evaluative

• Non-judgmental

Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81

Verbal Feedback in Surgery

• Prevalent surgical culture prone to negative and evaluative feedback

• “Constructive criticism” thought to be the best way to improve skills performance *

• Affects of feedback on teacher-learner relationships, and learner motivation to study and practice not well studied

*Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A randomized controlled trial. Med Educ. 2006 Aug;40(8):746-9.

Study Questions

• How do positive and negative verbal feedback affect immediate skills performance?

• What is the effect of such feedback on the teacher-learner relationship?

• What is the effect of such feedback on the trainee's motivation to learn and engage in skills practice?

Study Specifics

25 1st year medical students with little to no laparoscopic experience

Negative Verbal Feedback (n=13)

Positive Verbal Feedback (n=12)

Repeat FLS peg-transfer task.

Survey Administered

Perform FLS peg- transfer.

Debrief

Skills Performance Results

Interpreting Results

• No significant difference in skills performance (time and number of errors)

• Could be due to non-specific nature of the feedback

• Most feedback in surgery is non-specific, learners unclear how to improve

Survey Results

Interpreting Results

• Teacher- Learner Relationship• Positive feedback from a mentor: relationship with that individual

would improve either somewhat (28%) or greatly (68%)• Negative Feedback from a mentor: relationship with that

individual would deteriorate either somewhat (28%) or greatly (72%).

• Individuals learn best from physicians they wish to emulate**Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5

Survey AnswerResponses to Positive Feedback Question (n=25)

Response to Negative Feedback Question (n=25)

Relationship    Deteriorate Greatly 0 (0%) 18 (72%)Deteriorate somewhat 0 (0%) 7 (28%)Stay the same 1 (4%) 0 (0%)Improve somewhat 7 (28%) 0 (0%)Improve greatly 17 (68%) 0 (0%)

Interpreting Results

• Motivation to Learn• Positive Feedback: either somewhat more (44%) or much more

(52%) inclined to learn about the subject. None reported a decrease in interest in the subject.

• Negative Feedback: one-third would be either less inclined (24%) or much less inclined (8%) to learn. Ten (40%) reported no change in their level of interest, while the rest would be either somewhat more inclined (20%) or much more inclined (8%)

Inclination to Learn Responses to Positive Feedback Question (n=25)

Response to Negative Feedback Question (n=25)

Much less inclined 0 (0%) 2 (8%)

Somewhat less inclined 0 (0%) 6 (24%)

No change 1 (4%) 10 (40%)

Somewhat more inclined 11 (44%) 5 (20%)

Much more inclined 13 (52%) 2 (8%)

Interpreting Results

• Motivation to Practice:• Positive Feedback: most would spend somewhat more (60%) or much

more (12%) time practicing, some reported no change in (24%) or less (4%) practice time.

• Negative Feedback: few would practice less (12%) or the same (16%); most would spend either somewhat more (36%) or much more (36%) time practicing.

Inclination to Practice Responses to Positive Feedback Question (n=25)

Response to Negative Feedback Question (n=25)

Much less inclined 0 (0%) 2 (8%)

Somewhat less inclined 1 (4%) 1 (4%)

No change 6 (24%) 4 (16%)

Somewhat more inclined 15 (60%) 9 (36%)

Much more inclined 3 (12%) 9 (36%)

Conclusions

• Survey results only a pilot- need more longitudinal study to determine veracity of results

• Unclear relationship of of verbal feedback to skills performance

• The subtle affects of verbal feedback on motivation to learn and practice need to be further researched

References

• Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A randomized controlled trial. Med Educ. 2006 Aug;40(8):746-9.

• Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81.

• Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5.

• Branch WT Jr, Paranjape A. Feedback and reflections: teaching methods for clinical settings. Acad Med 2002:77(12.1):4

• Sheehan TJ. Feedback: giving and receiving. J Med Educ. 1984; 59:913.

• Isaacson JH, Posk LK, Litaker DG, Halperin AK. Resident perception of the evaluation process. Society of General Internal Medicine. J Gen Intern Med 1995:10(Suppl): 89

• Kogan JR, Confroti LN, Bernabeo EC, et al. Faculty staff perceptions of feedback to residents after direct observations of clinical skills. Med Educ, 2012 Feb; 46 (2): 201-15

• Papousek I, Paechter M, Lackner HK. Delayed psychophysiological recovery after self-concept-inconsistent negative performance feedback. Int J Psychophysiol.2011 Dec; 82(3):275-82.

• Bienstock JL, Katz NT, Cox SM, et al. To the point: medical education reviews—providing feedback. Am J Obstet Gynecol. 2007 Jun;196(6) 508-13.

• Fundamentals of Laparoscopic Surgery Curriculum. http://www.flsprogram.org/