Evaluation and Feedback

Christina Surawicz, MD, MACGUniversity of Washington School of Medicine

With thanks to Dr. Eileen Klein and the UW teaching scholars 2005-06

Learning Objectives

1. Understand the importance of feedback

2. Learn techniques for giving feedback

3. Lean how to receive feedback

Definition of Evaluation

Measure of knowledge and/or skillsAlso called

• Assessment • Appraisal

Compared to • Peers • Absolute standards

Feedback vs Evaluation

Evaluation•Scheduled•Summative•Formal•Judgment based on comparison to peers or norms •Example: middle or end of rotation

Feedback•Brief•Formative•Nonjudgmental, specific, and descriptive•Focus on behaviors learner can modify•Example: right after clinical presentation

Evaluation of Fellows - Parameters

• Cognitive

• Procedures

• Communication

• Professionalism

How to Measure Professionalism

1. 360° evaluation - labor intensive

2. Two questions on evaluationThis individual treated me with

respectScale of 1 - 5

This individual treated others with respect

Scale of 1 - 5

Coaching and Feedback

Feedback is a term coined by the flight engineers to describe adirectional system that provides information to a rocket about its course and causes it to correct

Why is Feedback Important

for Trainees?

for Trainer?

Why Feedback is Important - Trainee

•Opportunity to improve

•Insight into their behavior

•Allows them to reach goals

Why Feedback is Important - Trainer

•Demonstrates interest and caring

•Allows one to see progress

•You are doing the right thing (personal fulfillment)

Providing feedback strongly correlated with students’ perceptions of effective teaching

(Elnicki & Cooper, JGIM 2005)

Important for the Profession

• Competent physiciansCorrect mistakes

• Underscores importance of feedback

• Underscores necessity for self-evaluation

Without Feedback: Silence

Assume approval – no news is good news

Assume disapproval – they probably all think I am hopeless

4 Generations Practicing Now

BornTraditionalists 1922 – 1945

Boomers 1946 – 1964

Generation X 1965 – 1979

Generation Y (Millennials) 1980 - 1994

Boomers

• Workaholic• Service oriented • Optimistic• Personal gratification• Technology

NiceNot necessary

Millennials

• Current trainees

• Culturally diverse

• Technology necessary

• Civic-minded

Giving and Receiving Feedback - Boomers

• Give “Once a year with documentation”

• Receives “I want to know how I’m doing”

Giving and Receiving Feedback – Generation X

• Give “Here it is now and it’s honest”

• Receives “I want to know now and often”

Giving and Receiving Feedback - Millennials

• Give “I’ll explain if something’s wrong”

• Receives “Whenever I want it, at the push

of a button”

Giving Feedback to Trainees

• Set up the expectation for feedback

• Be more concerned about the learner than yourself (Boomers)

• Feedback should have meaning (Millennials)

What are Barriers to Feedback?

Barriers to Feedback

• Not enough time• Not worth it- doesn’t work anyway• Prior negative experience• Unclear expectations• Effect on teacher-learner relationship• Lack of training!!!

Feedback - Three Strategies

• Pendleton’s Rules

• SETGO

• Ask - Tell – Ask – Act/Follow up

Pendleton’s Rules

1. What did you do well today?

2. What I think you did well

3. What could you do differently next time?

4. What I think you could do differently next time

Feedback Techniques: SET GO

• What I SAW (Describe what you saw)• What ELSE did you see? (What happened

next)• What do you THINK? (Learner reflection)• What GOALS are we trying to achieve?• OFFER suggestions on how to achieve goals.

Chowdhury, R. Learning to Give Feedback in Medical Education. The Obstetrician and Gynecologist, 2004; 6:243-7

Ask – Tell - Ask• Ask – How are things going?

Be specific – How did rounds go today?

• Tell – I observedBe specific

• Ask – how can you improve?

• Act/Follow up

Feedback Basics – Do’s

• Clarify situation

• Describe behavior

• Deliver impact

Useful Questions

• What are your goals?• How do you think it’s going?• What has gone well so far?• What could be improved?• What will you do next time?• What changes can you make?

Useful Phrases

• When you said . . . I was concerned because. . .• This is my suggestion . . .• Let’s reframe this issue . . .• Let’s reflect about what happened . . .• Let’s talk about this when the time and

location may be more appropriate. • Suggest a time/place or ask the learner to pick a

time and place • We all want what’s best for the patient

Feedback – Don’ts

• Be vague

• Be judgmentalYou always. . .

• Accuse

• Psychoanalyze

Role Play

Faculty or Attendees?

Let’s Practice - Case 1

It is a busy day on consult service, you have one fellow seeing consults. On rounds, the presentations are disorganized, incomplete, for example, an evaluation of a patient with rectal bleeding does not mention patient has abnormal LFT’s.

When? Where?• When to evaluate?

On rounds?After rounds?Next day?

• Where to evaluate?Outside patient’s room?Team room?Empty endoscopy room?

Ask

How do you think rounds went today?

Tell

You seemed unprepared to present the patients thoroughly; for example, the presentation on patient x did not mention her abnormal liver tests.

Ask

Is there anything that can help you see and evaluate these complex patients more efficiently?

Act/Follow Up

• Some suggestions for evaluation- ask the fellow to provide them!

• Let’s follow-up in 2 days

Case 2

Attending Perspective

You have been on service for a couple days and you are not pleased with the fellow you are working with. Their presentations lack detail and you are worried they are not getting enough history to implement adequate plans. You also do not believe the consult notes are not clear enough.

You make a list of areas in which the fellow can improve and give it to the fellow.

Trainee Perspective

This is the first time you have been on service with this attending. They are very compulsive and seem to be involved in every detail of care. You are very thorough in your history taking and speak at length in person to the team about your recommendations of care for the patients you consult.

You believe the list of areas in need of improvement is not accurate.

What are the issues and how can they be remedied?

Issues

• Expectations not set up ahead of time• Do not fully understand each others

perspective• Feedback not requested/permitted• Feedback not in person• Solutions identified by attending without

eliciting information from fellow and before discussion

Case 3

Fellow Perspective

Another busy day on service and you are running to your next consult. On your way you have been stopped in the hall four times by residents to answer “quick” questions about their patients. You politely do so in every case and are able to finish all of your work before afternoon rounds. You are proud of your thoroughness, efficiency and professionalism.

Attending Perspective

Just prior to afternoon rounds you hear about advice given regarding the care of a patient with recurrent C. difficile colitis. No formal consult was done and you are frustrated that the fellow would give advice on this case without a formal consult.

You mention this to the fellow on rounds and are surprised they are not more receptive to you.

Optimizing Feedback• Pick the time and place• Non-judgmental• Attending – Ask the fellow their perspective– Ask the fellow to come up with solutions

• Fellow – Ask to give your perspective– Offer solutions

Tips for Receiving Feedback

“Negative feedback is hard to take when given by a friend, relative or stranger”

Anonymous

But remember that Change is not possible without some element of conflict

Receiving Feedback

If you are a leader, you may need to ask for it especially form juniors

How to ask?3:13 things I am doing well1 thing I can improve

Receiving Feedback• Being open/approachable

ListenBody language

• RespondingReflect

• Don’tsArgueDefendGive excuses

• Reply? Later!!• Thank them for giving feedback

Questions?

Summary

1. Know the elements of evaluation for trainees

2. Understand the importance of feedback

3. Learn techniques for giving feedback

4. Lean how to receive feedback

To Do’s at Home

• Commit to giving feedback regularly and often

• Commit to asking for feedback -“what can I do better?”

You will be a great role model