Title: Providing Effective Feedback
1Providing Effective Feedback
- Faculty Professional Development
SeriesUniversity of Pennsylvania School of
MedicineSeptember 10, 2008 - Jennifer R. Kogan, M.D.
- Lisa M. Bellini, M.D.
- Department of Medicine
2Workshop Objectives
- Distinguish between evaluation and feedback
- Discuss principles of effective feedback
- Identify barriers to feedback
- Identify strategies to increase feedback and
improve skills delivering feedback
3Feedback vs. Evaluation
4- Feedback
- Conveys information
- Formative
- Current performance
- Neutral
- (verbs nouns)
- Foster learning
- Evaluation
- Conveys judgment
- Summative
- Past performance
- Normative statements
- (adjectives and adverbs)
- Certification
5Benefits of Feedback
- Assist learners to
- evaluate knowledge, practice skills
- define teachers expectations
- identify strengths/weaknesses without academic
penalty - remedy deficiencies
- Assist teachers to
- evaluate and modify coursework and teaching
- recognize student progress and achievement
6 Clinical Education Without Feedback
- Missed learning opportunities
- Student insecurity about abilities
- Inaccurate perception of performance
- Disappointment and surprise with final
evaluations
7- Principles of
- Effective Feedback
8 Principles of Effective Feedback
- Related to agreed upon goals
- Specific
- Reinforce positive outcomes and behaviors
- Provide guidelines for improvement
- Quantity regulated, limited to remediable
behaviors - First hand, objective information
- Timely
- Descriptive not evaluative language
- Accompanied by explanations
- Includes an action plan
Ende J. JAMA. 1983 250 777-781
9- Feedback during clinical rotations appears to be
a rather intractable problem - in medical education
Irby DM. Acad Med 1994 69333-42
10- What Are The Barriers To Feedback?
11What Are Barriers to Feedback?
- Time constraints
- Limited information about learner performance
- Absence of standards of competence
- Inadequate knowledge of tenets of effective
feedback - Giving constructive feedback
- Concern about undesirable consequences for
student or teacher
12"You can observe a lot just by watching."
13"You can observe a lot just by watching."
14What are barriers to observing students/
residents with patients?
15Strategies to Increase Observation
- Frequent snapshots
- Pre-rounds
- First 5 minutes of the outpatient encounter
- Post-rounds counseling/discharge instructions
- Observe exam
16The Rules for Observation
- Tell learner you will be coming into the visit
- Be a fly on the wall
- avoid interrupting learner/patient dialogue
- avoid eye contact with the patient
- avoid interruptions
17Structured Approach to Deliver Feedback
18Set the Stage
- Create environment conducive to feedback
- Elicit learners goals beginning of rotation
- Establish expectation of continuous feedback
- Start session by telling learner this is your
feedback
19Conduct the Feedback Session
- Elicit learners self-assessment
- - what was done well
- - what needs improvement
- Provide feedback positive and negative
- Check for understanding
- Develop action plan/ determine how to monitor
progress
20Follow-Up
- Meet again
- Ensure action plan developed/in progress
21The Feedback Sandwich
22 Feedback Role Plays
23Scenario 1
- Faculty
- It is the end of the first week of a two week
rotation - and you are about to meet with the medical
student - who has been rotating with you. The medical
student is - enthusiastic, hard working and interested in
learning. The - student seems to enjoy working with patients, is
timely and is - always asking to see additional patients. You
are concerned - that the student is having difficulty presenting
a coherent, - organized history and physical exam and have
noticed that - the student's notes are similarly disorganized
with an - incomplete assessment and plan. You believe the
student's - knowledge base is borderline.
24Scenario 1
- Medical student
- It is the end of the first week of a four week
rotation. This is - your second core clerkship. You think that you
have been - doing a good job. You really like seeing patients
and are - eager to learn. You have tried to be enthusiastic
and a team - player. The office/ward has been very busy and
learning how - to do a focused patient visit has been a bit hard
since in - Introduction to Clinical Medicine you had 45
minutes to see a - patient and now you only have 15 minutes.
25Scenario 2
- Faculty
- It is the midpoint of your four-week rotation
with a medicine - core clerkship student. You had told the medical
student at - the beginning of the rotation that you would have
a mid - rotation feedback session. The medical student is
very bright - and has a superior fund of knowledge. He is able
to perform - a focused history and physical exam, synthesize a
problem - list, assessment and plan. However, the student
has arrived - late on three occasions and requested to leave
early another - day. Some of the nurses felt he has been curt and
abrasive. - The student once got visibly annoyed when
speaking with a - nurse earlier in the week.
26Scenario 2
- Medical student
- It is the midpoint of your four-week rotation and
you and - your attending are meeting for a planned feedback
session. - You haven't been too interested in this rotation
- you are - pretty certain that you are going into Radiology.
You believe - that you have done a pretty good job of seeing
patients and - have tried to come up with differential diagnoses
for the - patients you see. But overall, you are pretty
bored and are - looking forward to your next rotation which you
think will be - much more pertinent to your future career goals.
27Scenario 3
- Faculty
- You are on morning rounds with your resident,
- intern and medical student. The team had a very
- busy night and admitted several sick patients.
One - patient was admitted with dyspnea. The patient
was thought - to have an asthma flare and was given nebulizers.
Oxygen - saturations levels were checked throughout the
night. A CXR - was not done and no oxygen was ordered. While at
the - bedside you notice the oxygen saturation of 85
and the - patient in respiratory distress.
28Scenario 3
- Intern
- You have just finished a very busy call night.
- You did not have time to see all of your patients
- before attending rounds. You get to the bedside
of - this patient and begin your presentation. As you
- begin talking about the physical exam, the
attending - picks up the patient flow sheet and notices the
- hypoxemia. The attending enters the room to find
- the patient in respiratory distress . . .
29Tools to Increase Feedback
30Feedback Toolbox
- Mid rotation feedback forms
- Read/distribute feedback article
- Mini-CEX or encounter cards
- Learners contract
- Prime learners for feedback
- review tenets of feedback at orientation
- prompt students during course
- teach students how to ask for it