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Constructive Feedback 101 A Guide to the Fundamentals of Standardized Patient Feedback Standardized Patient Program University of Toronto 2007

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:

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