Effective Feedback

1
Effective Feedback

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

2
Objectives

• Perform a self-assessment of your feedback skills
• Discuss your use of feedback as a teaching tool
• Discuss barriers to feedback
• Practice giving effective feedback

3
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)

4
Feedback Definition

• Guide for teachers and students
• Focus for learning activity
• Developmental guide to achievement

5
Feedback

• What students have achieved
• What students might achieve
• What students are ready to achieve
• (Crooks, 1988)

6
Feedback Goal

• Support and foster students
• self-directed learners

7
Objectives of Feedback

• Helps learners to
• Determine expected standards
• Identify gaps between standard and actual
  performance
• Improve learning and performance
• Helps teachers to
• Adapt teaching to learners needs
• Keep up with learners progress

8
NEEDS
What ought to be
What is
9
What is believed to be real
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
10
In other words

• Feedback in clinical education is
• Speci?c information about the comparison
  between a trainees observed performance and a
  standard, given with the intent to improve the
  trainees performance.
• J M M van de Ridder et al(2008)

11
Faculty barriers to feedback

• Time constraints
• Absence of standards for competent performance
• Lack of direct knowledge of learners performance
• Discomfort in giving constructive (negative)
  feedback
• Unfamiliar with providing effective feedback

12
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.

13
Activity

• On the card, as a pair, write what you consider
  to be the basic principles of feedback.

14
Principles of feedback

• Planned - learners need to know
• when feedback will be given
• who will give it
• what will be given
• how it will be given

15
Principles of feedback

1. Timely and prompt - as closely as possible to
   performance.
2. Specific - describes behaviors.
3. Constructive -provides guidelines for
   improvement.
4. Limited to changeable behaviors.
5. Manageable - 1 to 3 behaviors.

16
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.

17
Timing of feedback

• During/soon after patient contact
• End of each half day or day
• Mid rotation
• End of rotation

18
Who can contribute?

• Self
• Peers
• Faculty
• Other team members
• 360-degree feedback

19
Feedback Session

• Be clear about purpose
• Get learners perspective on how things are going
• Use sandwich technique
• Ask recipient to rephrase feedback
• Ask recipient for solutions
• Develop a learning plan together
• Schedule a follow-up meeting

20
What would you consider as ineffective vs
effective feedback?
21
Ineffective vs Effective feedback

• Ineffective Effective Competencies that are
  Well observable tasks and
• not observable
  competencies
• Uninformed or non-expert Expert
  observer and
• observer
  feedback provider
• Global information Highly speci?c
  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

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• Without feedback, mistakes go uncorrected, good
  performance is not reinforced and clinical
  competence is achieved incidentally or not at
  all.
• Jack Ende, 1983

23
Case Scenario

• John is a very energetic learner, to the point of
  being aggressive. He prepares extensively for
  teaching sessions, reads exhaustively and
  participates actively in discussions. In fact, he
  tends to monopolize discussions often ignoring
  comments of his classmates.
• In pairs, discuss how and what feedback you will
  give to him.