Giving Effective Feedback - DOC

							                      Giving Effective Feedback


                           Joseph Lopreiato MD, MPH
                         Associate Professor of Pediatrics
                Uniformed Services University of the Health Sciences
                               Bethesda, Maryland

                            e-mail: jlopreiato@usuhs.mil
                              telephone: 301-295-4897




Goal:
   To help you deliver effective feedback to learners

Objectives:
   Review of general rules of the road for feedback
   Observe and critique a feedback session
   Do your own feedback on a video resident
   Discuss how to create a climate of feedback in your program




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       Introduction


Questions to ponder:

1. What is the definition of Feedback?


2. Where did the term come from?


3. What is the difference between feedback and evaluation?


4. If feedback is not given, what are the consequences for learners?




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Some thoughts…….

Academic Managers

As Program director, you are the chief education officer for your program. As such, you are responsible for
the teachers in your program. Teachers can be categorized as occasional teachers who have intermittent
contact and give intermittent feedback to your residents and core teachers, who are responsible for more
regular feedback and evaluation of your trainees.

You must ensure that feedback is being accomplished in order that your trainees gain maximum benefit
from the training experience. In order to monitor feedback in your program, you must:
 Know what good feedback looks like
 Practice it yourself
 Teach it to others


What do teachers and educators need for feedback?
For teachers: they need specific criteria that fit the clinical situation in order to give effective feedback

For academic managers:      Ask yourself: Is the feedback being effective in shaping competencies your
                            program desires?

                            Competencies such as:
                             Application of clinical knowledge
                             Communication skills
                             Professionalism
                             Psychomotor skills




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            Getting started        Rules of the Road for Effective Feedback


Step 1:

Be observant - know which criteria you are going to use to judge performance

Establish your checklist up front – what are your criteria?
e.g. Presentations

Step 2:

Be well timed and expected in giving feedback

Set expectations beforehand: “I’ll listen to your cases and give you feedback

Step 3:

Start off with the learner’s assessment of performance

Key: Ask 1st to get insight / issues to be addressed

Step 4:

Focus on the behavior and give specific examples

Behavior: “Your organization of presentations should include….
Not Personality: You seemed lost in space on that last presentation

Step 5:

Be positive when deserved – consider Feedback Sandwich

Study by Davis and Jacobs: Sandwich is effective in study of feedback to college students

Don’t serve a Baloney sandwich!!

Step 6:

Explore ways to improve performance

Leave the session with a plan for improvement




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                            Checklist for Feedback

    Tape

1          2

__         __   TEACHER HAD SPECIFIC CRITERIA TO JUDGE THE LEARNER’S
                PERFORMANCE

__         __   FEEDBACK WAS WELL TIMED AND EXPECTED

__         __   INSTRUCTOR ASKED FOR THE LEARNER’S OPINION

__         __   FEEDBACK WAS FOCUSED ON SPECIFIC OBSERVED
                BEHAVIORS

__         __   TEACHER NOTED WHAT WENT WELL AND WHAT DID NOT

__         __   TEACHER AVOIDED VAGUE GENERALIZATIONS

__         __   TEACHER EXPLORED WAYS TO IMPROVE PERFORMANCE




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                        Giving Feedback to your video resident




Step 1: List the criteria by which you will judge this resident in this clinical situation:









Step 2: Start off with the learner’s assessment of their performance


Steps 3-5: Give the feedback – don’t forget to:

   Be Specific (about observed behaviors, not generalities)
   Be Descriptive (but no personal attacks)
   Use feedback sandwich (but not a baloney sandwich)
   Tips for improvement (end with specific plan of action)

Write your feedback notes here:


Case 1




Case 2




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Closing Thoughts:


1. How would you establish a climate of feedback in your program?




2. How would you monitor such a program?




3. How do you as an educational manager receive feedback?




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                               Annotated Bibliography


1. Ende J. Feedback in medical education. JAMA 250:6,777-781, 1983

      The landmark article. Succinct guidelines for giving effective feedback.

2. Woolliscroft JO. Teaching and learning in the ambulatory setting. Acad Med.
64:11,644-648, 1989.

      Two consistently insightful educators reminding preceptors that it is okay to pick
       and choose teachable moments and feedback opportunities on a given day ….just
       do it!

3. Hilliard. AJDC v144 p1106 Oct 1990

       Survey of pediatric residents and fellows at Hospital for Sick Children, Toronto.
        One of the top 10 qualities of an excellent teacher was giving feedback

4. Hewson. J Gen Intern Med v13:p.111, 1998

       Study of feedback techniques on a group of MD’s found that feedback was most
       helpful when:
        Based on observations
        Focused on specifics
        Focused on behaviors, not personalities

5. Davies and Jacobs Small Group Behavior v16: p.387, 1985

       Study of feedback to college students.
        Feedback sandwich: good-bad-good, more effective than bad-good or good-
          bad

6. Irby. Acad Med v.69: p333, 1994

       Study of six master teachers giving lots of feedback during rounds.
        Feedback routinely embedded in teaching often went unrecognized by
          learners




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