On Delivering (And Receiving) Feedback

On Delivering On Delivering (And Receiving) Feedback(And Receiving) Feedback

John T. Benjamin MDThe Teaching Center

UNC Department of Pediatrics

The Teaching CenterThe Teaching Center

Teaching ThoughtsTeaching Thoughts

• “Teaching is not a lost art, but the regard for it is a lost tradition.” Jacques Barzun

• “Teachers need to be and teach learners how to be stewards for self-directedness.”

John Parboosingh MD

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Why Give Feedback?Why Give Feedback?

• An essential part of training and of measuring teaching effectiveness.

• Should encourage self-reflection, raise self-awareness; help students plan for future learning and practice keeping self-image intact.

• Can help prevent distress (burnout)

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Feedback vs. EvaluationFeedback vs. Evaluation

• These two terms are not equivalent.

• Evaluation is what is done at the end of the experience with the learner. Feedback should be happening as go along.

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2 Types of Feedback2 Types of Feedback

• Formal: scheduled; this is incorporated into the evaluations of learners.

• Informal: daily as relates to specific events: presentations, write-ups, behavior, etc.

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How often should formal How often should formal feedback occur?feedback occur?

• Learners state that doesn’t happen often

• Teachers state it occurs more often than learners think.

Recommendation:

Always label: “now you are getting feedback”

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Barriers to Giving FeedbackBarriers to Giving Feedback

• Our own feelings of inadequacy• Arranging time to do it

• Others?

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Receiving vs. Giving FeedbackReceiving vs. Giving Feedback

• Do you recognize yourself, your teachers in any of these descriptions?

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Receiving Feedback: Receiving Feedback: Learner is:Learner is:

• Negative/Closed» Disrespectful, closed, inactive listening,

rationalizing, patronizing, superficial, denies, defensive, attacking

• Positive/Open» Open, responsive, accepting, respectful,

engaged, active listening, thoughtful, interested, sincere.

• Think about feedback you have received and give examples of how you responded in each of these ways

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Giving Feedback: Giving Feedback: Teacher is:Teacher is:

• Ineffective/Negative Delivery» Vague, insensitive, disrespectful,

judgmental, general, poor timing, impulsive, selfish

• Effective/Positive Delivery» Supportive, direct, sensitive, considerate,

descriptive, specific, good timing, helpful

• Give examples of both that you have experienced

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How Do We Give Effective How Do We Give Effective Feedback?Feedback?

• Day 1 Expectations of when meet• Do it at the right time and right way• Be supportive and specific• Summarize at end and state when will occur

again

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Day 1 Clarify ExpectationsDay 1 Clarify Expectations

• “Friday will be feedback day”• Then on Friday, make sure you give each

person feedback or reschedule if you have to. You have made a commitment to do this.

• On day 1, explain why feedback is so important to have done – this motivates learners to do their best.

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Feedback: Formal Feedback: Formal 5-10 minutes a Week5-10 minutes a Week

• Organized in advance and predictable – not just when things go wrong. Private setting.

• Start by saying: This is our feedback session. • Then ask: “How do you think things are

going?” and then listen carefully.• If no response then: “What things are going

well for you? Not so well?”

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Criteria for Giving FeedbackCriteria for Giving Feedback• Given with Care• Given with

Attentive Listening• Invited by Learner• Specific• Fully Expressed

• Objective• Well-timed• Directed toward

changeable behavior

• Checked and clarified

• Evaluated

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Do not give feedback when:Do not give feedback when:

• Learner is post-call

• You are tired and/or angry at the learner

• Other responsibilities conflict with the interaction

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Do not be vague: eg don’t say:Do not be vague: eg don’t say:

• Good Job (doesn’t mean much)• You are doing great (ditto)• You did …….; you said…….; you were

disorganized……you were better at the beginning of the presentation……;

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Be as specific as you can: do Be as specific as you can: do say:say:

• Overall, I think things are going well, but:» I observed that…..» Could you clarify…. » It seems to me…..» In your presentation, it would have been

helpful if you had…..

• When would you like to meet next for a followup to this meeting?

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Giving Positive FeedbackGiving Positive Feedback

• Needs to be specific• Shows spontaneity, variety – not the same as

you gave the student before this one.• Rewards specific effort that you noticed• Provides information about competence,

value of accomplishments, progress

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Unanticipated Consequences of Unanticipated Consequences of Giving Positive FeedbackGiving Positive Feedback

• Often confirms learner’s opinion of themselves.

• You are considered omniscient• You get a good evaluation from the learner.

One faculty member said: “I am very popular with students – I give them all honors.”

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Giving “Constructive” Giving “Constructive” FeedbackFeedback

• If learner comes up with areas to work on:» Develop a plan of action which includes

rechecking with learner in a few days» Must also include areas that are going well

and emphasizing the importance of them.» Ask: “What are you going to change?”» At follow-up session, praise specific

improvement: “this is much better, because..”

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Unanticipated Consequences of Unanticipated Consequences of “Constructive” Feedback“Constructive” Feedback

• If negative enough, learner will “ding” teacher on teacher evaluation.

• Learner may not say “thank you”• Learner may not really learn much or change

their ways, but some will.• Makes you feel bad – this is not why we went

into teaching• What if learner doesn’t get it?

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Conclude FeedbackConclude Feedback

• Summarize and give a plan of action if needed.

• If problem, identify specific time to meet again in 3-4 days.

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Our JobOur Job

• Give feedback that is constructive; learners will consider it either positive or negative, but our goal is to help the learner improve and grow.

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Video of Giving FeedbackVideo of Giving Feedback

• Show video• Discuss: what did senior person do well?

What did senior person not do well?• What did learner do well?• What did learner not do well?

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Exercise - Groups of 3:Exercise - Groups of 3:1 learner, 1 teacher, 1 observer1 learner, 1 teacher, 1 observer

• Example 1. Student seems uninterested, gives poor eye contact and messes with palm pilot constantly.

• Example 2: Student shows up late and leaves early. He seems unhappy; has gotten only A’s so far.

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Exercise #2 – score sheetExercise #2 – score sheet

• Score Sheet: Observer to give feedback to the teacher; learner can add opinion as well.

• If time for a second case, rotate roles.

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Evaluation: Base on levels of Evaluation: Base on levels of Learning RIME:(Lewis First)Learning RIME:(Lewis First)

• Observer only (F)

• Reporter only (+/- P)

• Interpreter (HP)

• Manager (H)

• Educator: Resident Level

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Evaluation: Grade as a GroupEvaluation: Grade as a Group

• Issues with Honors/High Pass/Pass

• Combine forces with other attendings to come to group consensus! (example of how not to do it: Teach Attending/generalist).

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Evaluation: despite Evaluation: despite our best effortsour best efforts

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Summary and ConclusionsSummary and Conclusions

• Feedback should be given on each rotation• Day 1 – set expectations• Always be constructive and positive• Recognize: Not everyone will be ready to

hear what you have to say.

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