Feedback

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Feedback Evaluation Quick Tips for Clinical
Preceptors (Part 1)

• Shirley Schlessinger, MD, FACP
• Associate Dean for Graduate Medical Education
• University of Mississippi Medical Center

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You can observe a lot just by watchin.

• Yogi Berra
• But things will never CHANGE if you dont comment
  on what you see!

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Why ? (You know its important!)

• Performance does not reliably improve without
  evaluation and feedback
• Key responsibility of the clinician-teacher
  faculty member
• ALL of us can get better at what we do

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Why not? (Our lowest scores as faculty!)

• I didnt have enough exposure to the trainee
• I dont know what to say
• Am I being fair?
• I dont want to hurt their feelings
• I dont want to hurt their career
• I dont want to be sued

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SoLets get better!!!

• Clearly establish expectations for learners
• Understand the tools you need for evaluation
  (assess /measure!)
• Have faith in your learners desire to improve!
• Develop skills in targeted observation and
  constructive feedback

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Feedback Shapes Behavior

• Timely
• Objective
• Focused
• Useful

• What did the learner do well?
• Where do they need to improve?
• What are next steps they can take?

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Prepare Resident for Feedback

• Why feedback will be given?
• Be all that you can be
• When will feedback be given?
• Micro-feedback
• Macro-feedback
• Formative Summative evaluations
• How will feedback be given?
• Provide this info at the BEGINNING of the
  rotation STICK to the PLAN!

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Micro vs- Macro Feedback

• MICRO
• Instantaneous
• Pure coaching
• Flexible format
• May be given in group setting
• May occur in response to a single observation

• MACRO
• Cumulative over time
• May be formative or summative
• Coaching Judging
• Structured format (competency based)
• Should be a private session

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Micro Macro Feedback

• More effective when initiated with
  self-evaluation
• Should be clearly linked to expectations / goals
  and objectives
• Should be linked to next steps
• Macro-feedback should build on and reinforce
  microfeedback!

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Microfeedback Template

• Look for behaviors to reinforce as well as
  correct
• Provide immediate feedback when possible
• Be brief and focus on a single issue
• Be specific about what you saw
• Avoid speculating on intentions
• Use nonjudgmental language
• Encourage self-evaluation and reflection
• Identify next-time behaviors

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Preparing to Give Macro- Feedback

• Read your residents notes
• Consciously observe your residents interacting
  with families, nurses, pharmacists, social
  workers
• Watch your resident examine patients
• Probe your resident for evidence-based decision
  making
• Consider patterns of behavior
• Consider how your resident has responded to
  micro-feedback
• Identify a private place to provide feedback

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Macrofeedback Template

• Ask What do you see as your strengths? What
  do you see as your weaknesses
• Tell Summarize your observations and ideas
  include both positive and negative feedback in
  each competency domain if possible (even the best
  resident can get better!!!)
• Ask What are your next steps? guide
  resident in developing goals for growth

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Hints for Tell

• Focus on observations You did such and such
  versus You are
• Focus on descriptions, not judgments What I
  observed was versus Your examination was
  inadequate because
• Focus on specific details, not generalities At
  the start of the interview with Mrs. Jones, I
  noticed versus Your introductions are all

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DO

• Define expectations early
• Get DATA (Observe, Observe, Observe)
• LABEL it FEEDBACK!
• Target to trainee level
• Consider timing
• Give feedback regularly
• Ask for self-evaluation by trainee
• Be positive when deserved
• Be specific as possible
• Focus on the clinically significant
• Encourage trainee responsibility

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DONt

• Dont be angry when giving feedback
• Dont give feedback in public or emotionally
  charged settings
• Dont try to cover too much
• Dont lecture
• Dont be completely negative (NEVER be
  demeaning)
• Dont provide compliments only
• Dont criticize the personality (behavior!!)
• Dont ignore problems!!
• Dont wait until the end to give negative
  feedback
• Dont put negative comments on paper, until
  discussed in person

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Without feedback, mistakes go uncorrected, good
performance is not reinforced, and clinical
competence is achieved empirically or not at
all Jack Ende, 1983Do not ignore
problems!They will NOT go away
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And finally

• Fill out the WRITTEN evaluations requested by the
  education office in a TIMELY fashion!!
• This is a measure of YOUR professionalism!
• Provide written comments
• Source of motivation for high performers
• Road-map for improvement for others
• Remembered by learner LONG after numbers are
  forgotten!!!
• Promote personal growth