Effective Feedback Win May, MD, PhD Beverly Wood, MD, PhD Division of Medical Education Keck School of Medicine University of Southern California.

Effective Feedback

Win May, MD, PhDBeverly Wood, MD, PhD

Division of Medical EducationKeck School of Medicine

University of Southern California

Objectives

Perform a self-assessment of your feedback skillsDiscuss your use of feedback as a teaching toolDiscuss barriers to feedbackPractice giving effective feedback

Feedback: 3 definitions

Concept Characteristic

Information - Focus is message content

Reaction - Focus is interaction with information

Cycle - Focus is receiving information,

responding to data, and improving

response quality

J M M van de Ridder et al(2008)

Feedback: Definition

Guide for teachers and students

Focus for learning activity

Developmental guide to achievement

Feedback

What students have achievedWhat students might achieveWhat students are ready to

achieve

(Crooks, 1988)

Feedback: Goal

Support and foster students

self-directed learners

Objectives of Feedback

Helps learners to:Determine expected standardsIdentify gaps between standard and

actual performanceImprove learning and performance

Helps teachers to:Adapt teaching to learners’ needsKeep up with learner’s progress

What is

NEEDS

What ought to be

Professionalstandards/guidelines

External indicatorcharts

What is believed to be real…

Personal standards

Personal perceptions

Fox, R.D. and Miner, C. “Motivation and the Facilitation of Change, Learning and Participation in Educational Program for Health Professionals”. Journal of Continuing

Education in the Health Professions, Vol. 19, No. 3. Summer 1999

In other words……

Feedback in clinical education is:

“Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance.”

J M M van de Ridder et al(2008)

Faculty barriers to feedback

Time constraintsAbsence of standards for competent performanceLack of direct knowledge of learner’s performanceDiscomfort in giving constructive (negative) feedbackUnfamiliar with providing effective feedback

Learner concerns with feedback

Non-specific - does not help learning or performance

Personal - statement about worth or potential (embarrassing or humiliating)

Not linked to learning outcomes

Not timely - too late to change performance

Not progressive - no sense of what they have achieved in progress towards a goal or have yet to achieve.

Principles of feedback

1. Planned - learners need to know

when feedback will be given who will give it what will be given how it will be given

Principles of feedback

2. Timely and prompt - as closely as possible to performance.

3. Specific - describes behaviors.

4. Constructive -provides guidelines for improvement.

5. Limited to changeable behaviors.

6. Manageable - 1 to 3 behaviors.

Principles of feedback

7. Empathize with learner

8. Verify - learners understand feedback.

9. Plan - action plan with learner.

10.Follow up - check with learner on achievement of plan.

Timing of feedback

During/soon after patient contact

End of each half day or day

Mid rotation

End of rotation

Who can contribute?

Self PeersFacultyOther team members

“360-degree feedback”

Feedback Session

Be clear about purposeGet learner’s perspective on how

things are goingUse sandwich techniqueAsk recipient to rephrase feedbackAsk recipient for solutionsDevelop a learning plan togetherSchedule a follow-up meeting

What would you consider asineffective vs effective feedback?

Ineffective vs Effective feedback

Ineffective Effective Competencies that are Well observable tasks andnot observable competencies

Uninformed or non-expert Expert observer and

observer feedback provider

Global information Highly specific information

Implicit standard Explicit standard

Second hand information Personal observation

No aim of performance Explicit aim of performance improvement improvement

No intention to re-observe Plan to re-observe

“Without feedback, mistakes Without feedback, mistakes go uncorrected, good go uncorrected, good performance is not reinforced performance is not reinforced and clinical competence is and clinical competence is achieved incidentally or not achieved incidentally or not at all.”at all.”

Jack Ende, 1983