Constructive Feedback 101 - University of Torontospp.utoronto.ca/sites/default/files/images/feedback...
Transcript of Constructive Feedback 101 - University of Torontospp.utoronto.ca/sites/default/files/images/feedback...
Constructive
Feedback 101
A Guide to the Fundamentals of Standardized Patient Feedback
Standardized Patient Program
University of Toronto
2007
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Table of Contents
Overview ............................................................................................................3
Characteristics of Feedback ...............................................................................4
The Structure of Giving Feedback .....................................................................5
Tips for Successful Feedback ............................................................................7
Troubleshooting tips ..........................................................................................8
Appendix I- Helpful Vocabulary ......................................................................9
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Overview
Why are Standardized Patients used?
♦ To allow students to practice/hone their communication skills with simulated patients
in a safe environment.
What is feedback?
♦ SP Feedback is information to a student about what the SP experienced in response to
what the student said or did during the interview.
♦ SP feedback focuses on his/her experience - not medical content.
When do we give Feedback?
♦ There are many contexts for giving feedback. Many of you will be working with first
year medical students in a course known as ASCM –the Art and Science of Clinical
Medicine.
♦ When you are being trained, part of the session will be focused on practicing
feedback.
♦ In the case of ASCM, you will be sent out to a teaching clinic to work with a group of
6 or 7 students who are being taught by a tutor (who is also a medical doctor). You
usually work with up to three groups in a session, sometimes less. You can ask the
tutor before you go in to do the simulation if he/she wants you to give feedback in a
particular way. Individual tutoring styles vary and some tutors will be very specific
about the kind of feedback that they want you to give while other tutors will be open
to anything you might offer. Each ASCM session also has a focus for the day. For
example, in Week 1 the focus is on initiating the interview.
Who do we give feedback to?
♦ Usually one student at a time. Sometimes tutors organize things so that one student
begins an interview and another student takes over and finishes the interview.
Sometimes students or tutors will call for a time out. When this happens, “go
neutral” and sit quietly. Don’t make contact with the student or tutor unless asked.
Sometimes tutors conduct a “round robin” which means that each student in the class
will ask you one question.
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Characteristics of Feedback
Feedback is…
1. Specific
“When you smiled and introduced yourself, I felt comfortable”
Is more effective than “You’re so nice”
2. Based on observable behaviour (behaviours which can be modified) i.e. what you
saw and/or what you heard
“You looked at the floor and changed the subject when I told you I was a
lesbian and I felt judged”
Is more effective than “You were homophobic when I told you that I was a lesbian”
How to give constructive feedback
Start with what you heard or saw and link it to an “I” statement in terms of how you
were impacted, affected, and/or felt.
Here are some examples:
“When you said _____ or did_____, I felt _____________________
I perceived I ______________
I noticed I _________________
I was _____________________
I experienced _______________
“When you introduced yourself and offered me a seat, I felt welcomed
Is more effective than “You’re a very welcoming person”
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The Structure of Giving Feedback
♦ Transition from interview to feedback
♦ Opening to Feedback
♦ Body of Feedback
♦ Checking In
♦ After the session
♦ The transition from interview to feedback:
After the encounter is over:
…come out of “role”
introduce yourself…
♦ The opening to feedback:
Usually begins with the learners’
experience. Can be initiated by the
Tutor or SP
Ask a question …
“How was that for you?”
“How did you experience the
interview?”
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♦ The body of the feedback:
Make a few objective, specific
statements:
…something that worked and
something that needs improvement...
Use an “I” rather than “You” statement
Focus on the process not the content
A learner can only grasp a few key points during an encounter
♦ Checking in:
(There may or may not be an opportunity for checking in with the student - it depends on
the session)
You might ask:
“Do you have any questions?”
“Did that make sense to you?”
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Be prepared for the tutor to take over at this point
Watch your time and politely excuse yourself if necessary
Discreetly move on to the next room or out to the waiting area
After the session: reflect upon your experience of the encounter
For the SP
Feel free to contact your trainer
with any questions or concerns.
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SP Protocol
♦ Maintain professional behaviour inside and outside of the classroom.
♦ It’s a good idea to meet with the tutor a few minutes prior to your simulation to
discuss the structure of the encounter and review any questions you may have
eg. will they be using time outs, do they want your feedback, etc…
♦ Do not speak with the students “out of role” before or during the simulation – if at all
possible, avoid the students seeing you out of role.
♦ A “time out” is a valuable learning process for the student. When you are in a “time
out” period it is important for you to continue the simulation (i.e. facial expressions,
body language, etc.). However, DO NOT interact with the student or group until
“time in” is called. Note: your subsequent performance must not be modified by the
discussion during the “time out” period.
♦ Do not allow a tutor to change your simulation. You have been trained from an
actual patient case with the realistic physical findings, history and psychosocial
problems of that patient. If the tutor wants to change your simulation, explain that
you need to remain as you were initially trained and refer him to the SP Program
Director. However, if the tutor wants to “tune” your affect (to increase your anxiety
or decrease your anxiety, for example) or your “setting” (e.g. clinic, office,
emergency room, etc.), this is appropriate. Please record this change so that future
faculty can make decisions about this fine “tuning.”
♦ Feedback is given at the end of the encounter. It is usually not appropriate to give
feedback during a “time out” or between students. Realism will be better maintained
if the students do not see you out of role until the encounter is finished.
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Tips for successful feedback
Focus your feedback on what you “saw and heard” and how you experienced it
♦ Always give feedback from your perspective, as the patient
Keep it simple and specific – make 2 or 3 points
♦ Too much information can be overwhelming
♦ Focus on areas of strength and areas for growth
Avoid commenting on medical content
♦ Focus feedback on your experience of the process
♦ eg: body language, eye contact, being ‘heard’, feeling ‘judged’ etc.
Avoid using judgment terms such as “good” or “bad”/ “right” or “wrong”
♦ Remember you are providing information, not making judgments
♦ Avoid using the word “but” as it can negate everything that came before it
Do not compare students
♦ Everyone has unique areas of strength and areas for growth
You are there to offer information.
It’s not your job to change anyone’s behaviour
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Trouble shooting tips
♦ What to do when the tutor contradicts you
The tutor facilitates the session! It is fair that everyone has an opportunity to offer their
particular perspective. All perspectives should be welcomed. Do not engage in an
argument.
♦ What happens when there is no opportunity for feedback until later in the
session rather than immediately after the interaction? (This will often mean
you will be expected to talk about several different student interactions.)
Be aware that the feedback might be more general. It is important not to compare
students.
♦ How to make use of a “Time-Out”
Time-outs are good opportunities to collect your thoughts about the feedback you plan to
give. Listening to what transpires during time-outs will also give you insight into
teaching and learning concerns of the group. Simply pause, stay in role in a neutral
position. Disconnect from the learner and other attendees and wait for the signal to
resume.
♦ Personal issues i.e. language, dress, body odour
Language: Sometimes the learner is hard to understand because of a heavy accent or
fluency. Be honest; tell the student that you have had difficulty understanding them.
Dress: If it interferes with the interview or gives an unprofessional impression, items of
dress should be mentioned.
Personal issues: Feedback on personal matters (e.g. body odour, bad breath) is the
responsibility of the tutor and should be dealt with in a private setting.
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Appendix I
Helpful Vocabulary
Following are suggestions of words you can use to describe feelings you may have during
an interview.
When feeding back on what was effective in the interview:
Reassured
Understood
Encouraged (to talk/tell)
Relieved
Cared for
Satisfied
At ease
Guided
A connection or connected
Cheered up
Comfortable
Confident
Grateful
Appreciated
Comforted
Hopeful
Supported Relaxed
Calm
Good
Pleased
Sympathized with
Important
Listened to
When feeding back on what was less effective in the interview:
Rushed
Patronized
Frustrated
Angry
Let down
Anxious
Provoked
Worthless
Tentative
Confused
Demeaned
Nervous
Foolish
Afraid
Put down
Embarrassed
Dehumanized
Uncomfortable
Alienated
Worried
Overwhelmed
Terrified
Pressured
Disconnected
Pessimistic
Judged
Annoyed
Unsure
Add your own words: