EFFECTIVE FEEDBACKEFFECTIVE FEEDBACK

Dr. Shama MashhoodDr. Shama Mashhood Senior RegistrarSenior Registrar Medical Education UnitMedical Education Unit CHS - KMDC CHS - KMDC

RATIONALERATIONALE for Giving Feedbackfor Giving Feedback

Without feedback, Without feedback,

Mistakes go uncorrected, Mistakes go uncorrected, High stakes outcomesHigh stakes outcomes

More RationaleMore Rationale

It is our responsibilityIt is our responsibility

It will help learners improve their It will help learners improve their performanceperformance

Can enhance the learner teacher Can enhance the learner teacher relationshipsrelationships

ObjectivesObjectives

Describe rationale for giving Describe rationale for giving feedback in medical educationfeedback in medical education

Describe common barriers to giving Describe common barriers to giving feedbackfeedback

Identify types of feedbackIdentify types of feedback

ObjectivesObjectives

Define characteristics of effective Define characteristics of effective feedbackfeedback

Observe and practice giving Observe and practice giving

feedbackfeedback

Develop an action plan for improving Develop an action plan for improving

feedback in your own practicefeedback in your own practice

Concept of FeedbackConcept of Feedback

In 1940 the Rocket Engineers In 1940 the Rocket Engineers developed this, Where the system developed this, Where the system used information to reach its goal.used information to reach its goal.

It is not a part of our culture…It is not a part of our culture…

“What feedback? No one ever gives me feedback”.

Barriers to FeedbackBarriers to Feedback

It is uncomfortableIt is uncomfortable avoid confrontationavoid confrontation Learner will not be receptiveLearner will not be receptive No one ever gave me F.BNo one ever gave me F.B not sure how to do itnot sure how to do it

BarriersBarriers

Time constraintsTime constraints Limited information about learner’s Limited information about learner’s

performanceperformance Giving only positive feedbackGiving only positive feedback Absence of standard of competenceAbsence of standard of competence

Essential components of Essential components of FeedbackFeedback

What was done wellWhat was done well What could be done betterWhat could be done better What will be done to improve next What will be done to improve next

timetime

Characteristics of Characteristics of FeedbackFeedback

Timely Timely Specific Specific DescriptiveDescriptive Constructive Constructive In an appropriate setting. In an appropriate setting. Allow the trainee input. Allow the trainee input. Focus on the positive.Focus on the positive.

1.1. Timely:Timely: Give feedback soon after an event and as Give feedback soon after an event and as

regularly as possibleregularly as possible

2.2. Specific;Specific;

“ “I liked how you did a thorough neurological I liked how you did a thorough neurological exam but exam but don’t forget to check the patient’s don’t forget to check the patient’s gait”gait”

Rather than global Rather than global

““overall, you are doing fine”.overall, you are doing fine”.

Descriptive ( Non-evaluative ):Descriptive ( Non-evaluative ):

I noticed you did not cover the patient I noticed you did not cover the patient during the examduring the exam

Not:Not: You have no respect for a patient’s You have no respect for a patient’s

privacyprivacy

Constructive:Constructive:

Help provide solutions for areas of Help provide solutions for areas of weakness. weakness. “what can be improved”“what can be improved” rather rather than than “what is wrong”“what is wrong”

Appropriate setting:Appropriate setting: Positive feedback is effective when Positive feedback is effective when

highlighted in the presence of peers or highlighted in the presence of peers or patients. patients.

Constructive criticism should be given in Constructive criticism should be given in privacy. privacy.

Trainee input:Trainee input: Trainees should be given the chance to Trainees should be given the chance to

comment firstcomment first

Involve attentive listening.Involve attentive listening.

Focus on the positive:Focus on the positive: concentrate on the act or behavior, not the concentrate on the act or behavior, not the

personperson

How to provide Effective How to provide Effective Feedback?Feedback?

The Old Feedback SandwichThe Old Feedback Sandwich

Praise

Criticism

Praise

Is it more palatable?

The New Feedback Sandwich*The New Feedback Sandwich*

Ask

Tell

AskAdaptation of “The New Feedback Sandwich,’ common in patient-physician communication literature; adapted by Lyuba Konopasek, MD, for use in feedback settings.

AskAsk

AskAsk learner to assess own performance firstlearner to assess own performance first–– What went well and what could have gone What went well and what could have gone

better?better?–– What were their goals?What were their goals?–– Have they ever seen a patient like this Have they ever seen a patient like this

before?before?

Begins a conversationBegins a conversation Assesses learner’s level of insight Assesses learner’s level of insight Useful for secondUseful for second--hand feedbackhand feedback

TellTell

TellTell what you observed: diagnosis and what you observed: diagnosis and explanationexplanation–– React to the learner’s observationReact to the learner’s observation

Feedback on selfFeedback on self--assessmentassessment–– Include both positive and corrective Include both positive and corrective

elementselements “I observed….”“I observed….”

–– Give reasons in the context of wellGive reasons in the context of well--defined defined shared goalsshared goals

Ask Ask (again)(again)

AskAsk about recipients understanding and about recipients understanding and strategies for improvementstrategies for improvement–– What could you do differently?What could you do differently?–– Give own suggestionsGive own suggestions–– Perhaps even replay parts of the encounter: Perhaps even replay parts of the encounter:

“show me”“show me”–– Commit to monitoring improvement togetherCommit to monitoring improvement together

Limit the QuantityLimit the Quantity

Checklist: The Feedback DialogueChecklist: The Feedback Dialogue

AskAsk learner to assess own performance firstlearner to assess own performance first What went well and what could have gone better?What went well and what could have gone better?

TellTell what you observed:diagnosis and explanationwhat you observed:diagnosis and explanation React to the learner’s observationReact to the learner’s observation Include both positive and constructive elementsInclude both positive and constructive elements Give reasons in the context of wellGive reasons in the context of well--defined shared goalsdefined shared goals Regulate quantityRegulate quantity

AskAsk about recipients understanding and strategies for about recipients understanding and strategies for improvementimprovement What could you do differently?What could you do differently? Give own suggestionsGive own suggestions Perhaps even replay parts of the encounter Perhaps even replay parts of the encounter -- show meshow me Commit to monitoring improvement togetherCommit to monitoring improvement together

Adaptation of “The New Feedback Sandwich,’ common in patient-physician communication literature; adapted by Lyuba Konopasek, MD, for use in medical resident feedback settings.

End with EndeEnd with Ende

““The important things to remember about feedback The important things to remember about feedback in medical education are that (1) it is necessary, in medical education are that (1) it is necessary, (2) it is valuable, and (3) after a bit of practice (2) it is valuable, and (3) after a bit of practice and planning, it is not as difficult as one might and planning, it is not as difficult as one might think.”think.”

Jack Ende, MDJack Ende, MD

Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:777-781.