The Skills of Providing The Skills of Providing ConstructiveConstructiveFeedbackFeedback

DR. MOHAMMED O. AL-RUKBANDR. MOHAMMED O. AL-RUKBANAssociate ProfessorAssociate Professor

Department of Family and Community MedicineDepartment of Family and Community MedicineCollege of Medicine, King Saud UniversityCollege of Medicine, King Saud University

من الله من رحم الله رحمعيوبي إلي' عيوبي أهدى إلي' أهدى

: الكريم الرسول :قال الكريم الرسول قالأخيه مرآة أخيه المؤمن مرآة المؤمن

• ObjectivesObjectives

• Q1.Q1. What is the definition of What is the definition of

feedback?feedback?• Q2.Q2. Why feedback? Why feedback?• Q3.Q3. How to conduct a feedback ? How to conduct a feedback ?• Q4.Q4. What is the difference between What is the difference between

feedback and evaluation?feedback and evaluation?

ContentContent……

• Q5.Q5. How frequent Feedback is used in How frequent Feedback is used in our medical education and why?our medical education and why?

• Q6.Q6. Who should give the feedback? Who should give the feedback?

• Q7.Q7. Where and for what behavior? Where and for what behavior?

• QQQQQQQQQQ??

• Summary and conclusionSummary and conclusion

ContentContent……

ObjectiveObjective......

The aim of this The aim of this presentation is to presentation is to

improve our skills of improve our skills of giving feedback to giving feedback to

students and traineesstudents and trainees

What is feedbackWhat is feedback??

What is feedbackWhat is feedback??

Coined in 1940s by Coined in 1940s by Rocket EngineersRocket Engineers

Feedback is a planned learning Feedback is a planned learning

experience during which a experience during which a personperson

who performed a task is who performed a task is helped to improve his helped to improve his performance through performance through

emphasizing on things done emphasizing on things done well and others that need well and others that need improvement and how?improvement and how?

What is feedbackWhat is feedback??

• Think about a situation in which you Think about a situation in which you received feedback that impacted on received feedback that impacted on you. you.

• Was it a positive experience or a Was it a positive experience or a negative experience? negative experience?

• What specifically do you remember? What specifically do you remember?

Why feedbackWhy feedback??

Why feedbackWhy feedback??

It is a very strong educational toolIt is a very strong educational tool

Without feedback …………….Without feedback …………….

mistakes go uncorrectedmistakes go uncorrected

good performance is not reinforcedgood performance is not reinforced

clinical competence is achieved empirically or clinical competence is achieved empirically or

not at all.not at all.Jack Ende, Feedback in clinical medical education JAMA.,1983

What Does the Research SayWhat Does the Research Say??

• Specific, descriptive feedback that Specific, descriptive feedback that focuses on success and points the focuses on success and points the way to improvement has a positive way to improvement has a positive effect.effect.

(Davies, 2002)(Davies, 2002)

• Clear, concise feedback matched to Clear, concise feedback matched to standards will promote student standards will promote student achievement.achievement.

(O’Connor, 2002)(O’Connor, 2002)

What Does the Research SayWhat Does the Research Say??

• Feedback generally produces positive Feedback generally produces positive results if teachers manage the form results if teachers manage the form the feedback takes.the feedback takes.

(Marzano, Pickering, & Pollack, 2001)(Marzano, Pickering, & Pollack, 2001)

• Students must be given the Students must be given the opportunity to apply the feedback by opportunity to apply the feedback by trying again.trying again.

(Black & Wiliam, 1998)(Black & Wiliam, 1998)

• The most powerful single modification The most powerful single modification that enhances achievement is that enhances achievement is feedback. feedback.

• The simplest prescription for improving The simplest prescription for improving education must be “dollops of education must be “dollops of feedback ”.feedback ”.

(Hattie, p 9)(Hattie, p 9)

What Does the Research SayWhat Does the Research Say??

How to conduct a feedback How to conduct a feedback sessionsession??

• Trainee:Trainee: Things he liked or did well.. Things he liked or did well..• Trainer:Trainer: Things they liked or did well.. Things they liked or did well..• Trainee:Trainee: Things to improve and how? Things to improve and how?• Trainer:Trainer: Things to improve and how? Things to improve and how?• Trainer:Trainer: Summarizes (positive points Summarizes (positive points

& specific suggestions for& specific suggestions for

improvements)improvements)

Feedback should beFeedback should be::

• Timely (the most effective)

Feed forwardMidpoint

FeedbackFeedback

START END

• Timely (the most effective)

• Interactive

• Short

• Specific

• Relevant

• Non-Threatening

• Non-judgmental

Feedback should beFeedback should be::

Which is more appropriate ?Which is more appropriate ?

A-A- The antibiotic regimen chosen did not The antibiotic regimen chosen did not provide coverage for H-influenza.provide coverage for H-influenza.

B-B- Your choice of the antibiotics Your choice of the antibiotics indicates a lack of appreciation for the indicates a lack of appreciation for the possibility of enterococcal infection.possibility of enterococcal infection.

A-A- You were great when you You were great when you presented the topic.presented the topic.

B-B- The case presentation gave me a The case presentation gave me a useful picture of the presenting useful picture of the presenting problemproblem

Which is more appropriate ?Which is more appropriate ?

• Non evaluativeNon evaluative

• Objective appraisal of performanceObjective appraisal of performance

• Not an estimate of trainees personal worth.Not an estimate of trainees personal worth.

• In a proper setting and In a proper setting and

Climate.Climate.

• Include Suggestions for improvementInclude Suggestions for improvement

Feedback should beFeedback should be::

What is the receivers’ impression on Feedback ?

• Adult Learners welcome feedback, Adult Learners welcome feedback, especially when it is based on their especially when it is based on their performance and tailored to their performance and tailored to their goals.goals.

Knowles MS. San Francisco, Calif; 1980.Knowles MS. San Francisco, Calif; 1980.

• Feedback, even corrective type, is Feedback, even corrective type, is seen as helpful and highly seen as helpful and highly appreciated.appreciated.

Hewson MG, Little ML. J Gen Intern Med;1998.Hewson MG, Little ML. J Gen Intern Med;1998.

What is the difference between What is the difference between feedback and evaluationfeedback and evaluation??

Feedback Evaluation Formative Summative

• Specific (not general) • In descriptive (non evaluative) terms.• Focus on the actions or decisions not

the person or the decision maker.

CommonlyCommonly RarelyRarely

How frequent Feedback How frequent Feedback is used in our institute?is used in our institute?

Why?Why?

1.1. Not use to it.Not use to it.

2.2. Failure to obtain data.Failure to obtain data.

3.3. ObservationsObservations are the currency of feedback.are the currency of feedback.

4.4. Teachers avoid hurting or embarrassment.Teachers avoid hurting or embarrassment.

5.5. Damage relationship.Damage relationship.

Why Feedback not used frequently?Why Feedback not used frequently?

Who should give the Who should give the feedbackfeedback??

Anyone who is in a position to

make a valid observation of the

trainee’s performance and who

is experienced enough with the

clinical problem and the

pedagogic problem.

• The person administratively in charge.The person administratively in charge.

• Third hand data.. Third hand data..

ee.g .g The chairman of the program The chairman of the program

(Dr- A) says to the resident :(Dr- A) says to the resident :

“ “ Dr. B said your six months ago knowledge is Dr. B said your six months ago knowledge is

alright but your clinical skills need more work”alright but your clinical skills need more work”

( The rotation finished around)( The rotation finished around)

Who is the least able Who is the least able to offer Feedback to offer Feedback??

• History History

• P/EP/E

• Case presentationCase presentation

• Ward roundWard round

• progress notes…..progress notes…..

Where andWhere and for what behavior? for what behavior?

TAKE HOME MESSAGESTAKE HOME MESSAGES

• In most classrooms providing In most classrooms providing FEEDBACK are frequently FEEDBACK are frequently underused! underused!

• FEEDBACK is a very effective tool FEEDBACK is a very effective tool for a student and teacher to for a student and teacher to improve education.improve education.

• There is difference between There is difference between FEEDBACK and EVALUATION.FEEDBACK and EVALUATION.

QQQQQ???

Further ReadingFurther Reading• Attached papersAttached papers• Ende J. Feedback in clinical Medical Education. Ende J. Feedback in clinical Medical Education.

JAMA 1983, 250.JAMA 1983, 250.• Ferenchick G, Simpson D et al. Strategies for Ferenchick G, Simpson D et al. Strategies for

efficient and effective teaching in the Ambulatory efficient and effective teaching in the Ambulatory care setting. Academic Medicine 1997,72 (4): 277-care setting. Academic Medicine 1997,72 (4): 277-280.280.

• Steinert Y. Twelve tips for effective small group Steinert Y. Twelve tips for effective small group teaching in the health professions. Medical teaching in the health professions. Medical Teacher 1996, 18(3):203-207.Teacher 1996, 18(3):203-207.

• A videotaped lecture by Dr. Basil Al SheikhA videotaped lecture by Dr. Basil Al Sheikh

Further Reading 2Further Reading 2• Ron and Susan Zemke entitled “Adult Learning: What Ron and Susan Zemke entitled “Adult Learning: What

Do We Know For Sure” in Training magazine, 1995, Do We Know For Sure” in Training magazine, 1995,

volume 32(6):31-40.volume 32(6):31-40.

• Harden RM, Crosby JR, Education Guide, The Good Harden RM, Crosby JR, Education Guide, The Good

teacher is more than a lecturer. The twelve roles of the teacher is more than a lecturer. The twelve roles of the

teacher.teacher.

• McLeod PJ, Harden RM. Clinical strategies for McLeod PJ, Harden RM. Clinical strategies for

physicians. Medical Teacher 1985,7 (2):173-189physicians. Medical Teacher 1985,7 (2):173-189

• Book titled ?? “The Medical Teacher” by Prof. HardenBook titled ?? “The Medical Teacher” by Prof. Harden