Effective Feedback

Fiona Spencer

What is feedback?

‘information given to a trainee with the intention to improve their performance’

When do we give feedback?

When do we give feedback?

• When a trainee undertakes a WpBA?• When completing a CS report?• When completing an ES report?• When a trainee makes a mistake?• When a trainee undertakes a procedure?• When a trainee does something well?• After an examination?

When do we give feedback?

All the time!

Known to self Unknown to self

Known to others OPEN BLIND SPOT

Unknown to others

FAÇADE CLOSED

Why do we give feedback?

Johari’s Window

Strengths Areas for development

Appraisee 1 3

Appraiser 2 4

Why do we give feedback?

A Simple Model of Competence

Does

Shows how

Knows how

Knows

Evaluation

Analysis

Synthesis

Comprehension

Facts

Open QuestionHow well have you managed this patient?

What have you learnt?

In this patient, what is the diagnosis?

Is there a treatment plan?...likely outcome?

What do these findings mean?

What are the causes?...effects?

What do you understand by…?

What, when, where?

HIERARCHY OF KNOWLEDGE – determining the learner’s knowledge

Adults learn best when:

When clear objectives are set– And they help set them

• The learning is purposeful and structured – Relevant to their needs

• They are actively involved• A variety of learning methods are used• Builds on their previous experience• When feedback is given • They engage in reflection

Few trainees perceive they receive regular effective feedback

Sometimes we don’t give good feedback

Feedback boxes on WpBAs

“Read more around subject”“Do more”“More practice”“Do harder cases”“No problems”“Competent”

So what makes it effective/good feedback?

• In order to be effective it must be given and received appropriately– Given immediately if possible so fresh in mind– Builds on strengths and needs– Describes behaviour and impact– Specific and Sensitive– Involves the appraisee– Confronts important or difficult issues– Gives guidance on rectifying behaviour– Is understood and accepted by the appraisee– Is from a respected source

Effective Feedback

Why go over what went well?

• Use a positive critique– ‘Well done – I really liked the way you did ….’

This re-enforces good practice and encourages trainees to retain and build on the good aspects and not misinterpret this area

– Increases trainee motivation and completes the learning cycle of reflection, action planning and future repeat (improved) performance

Giving feedback when not so good!

• Trainees try to jump to this often but do positives first

• Retain the positive theme by feeding back what they can do to improve, rather than what they are not good at – ‘In order to make that even more effective….’

• Focus on 1 or 2 important areas for development at a time

Feedback – Pendleton’s rules• Clarify any points of information/fact; • Ask the learner what s/he did well – ensure that they identify

the strengths of the performance and do not stray into weaknesses;

• Discuss what went well, adding your own observations, re-enforce positives, keep to the strengths.

• Ask the learner to say what went less well and what they would do differently next time.

• Discuss what went less well, re-enforce what you agree with adding your own observations and recommendations of something you would like them to do differently

• Agree an action plan- get commitment from trainee and make sure they understood the points made

• In order to be effective it must be given and received appropriately– Given immediately if possible so fresh in mind– Builds on strengths and needs– Describes behaviour and impact– Specific and Sensitive– Involves the appraisee– Confronts important or difficult issues– Is understood and accepted by the appraisee

Effective Feedback

Is this a bit artificial?

• It can be with senior trainees so can use alternative approach

• Start with “Can I make a suggestion….”• Give 2 reasons why you think it is a good idea: one

suggesting what it would achieve and something it would prevent or solve

• Make an overall positive statement about the learner or their abilities– “With your expertise at X this would be likely to give

an excellent outcome…”

Feedback sandwich

• If you want to make a development point eg about a step in procedure or in a busy clinic

• Say something positive• Make development point• Say something positive

• How many positive points do we need to hear to cope with a negative one?

Informal vs Formal Feedback

• Day to day in context of work activities• Frequent• Discuss skills or specific behaviours in small

doses• Consider separate planned formal feedback

sessions• Prepare by collecting info from other sources

too

Practice giving feedback

• Notes re scenarios and role play• In 3s– Trainee– Trainer– Peer observer

Examples of good feedback?

Make WpBAs more valuable

• Make sure you record the feedback given• Timely fashion • Make sure trainee reflection is included– Pendleton’s rules

• Be focussed, specific objectives– SMART

• Ask trainee to repeat the task working on those areas to show development – Agreed action plan

What else to give feedback on?

• Think about other useful areas– Communication skills/attitudes to staff or patients– Consent– Documentation– Running a list of procedures– Coping with case load– Time management– Supervising a junior trainee– Quality improvement ideas/projects– Organising teaching– Chairing a meeting

Summary

• When to give feedback – All the time• Why we give feedback – Encourages learning• How not to give feedback• What is effective feedback• Ways to give feedback -Pendleton’s rules• Practiced feedback