Post on 29-Mar-2015
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