Giving Feedback. chapter 40. A practical guide for medical teachers. Harden

Assessment section: chapter 40. Giving

feedback

In this presentation: 1) Introduction 2) What is feedback3) Formative feedback V.S summative evaluation4) The intent of a feedback session5) Importance of feedback6) Barriers 7) Principles of effective feedback8) Templates 9) Other approaches10) Training faculty to give feedback

1 )Introduction

Feedback is an essential component of the teaching and learning process.

Constructive feedback from the teacher gives the learner insight into his or her actions and their consequences.

Feedback allows the learner and teacher to successfully achieve both personal and course or program objectives.

The ideas and strategies in this chapter are intended to help make feedback a more productive experience for both the teacher and the learner.

2 )What is feedback?Information describing students’ or house officers’performance in a given activity that is intended toguide their future performance in that same or arelated activity

3 )Formative feedback V.S summative evaluation

1 )Formative2 )Midcourse

adjustment3 )Descriptive

and neutral4 )Task oriented

5 )Frequently give

6 )Given as soon as feasible

feedback 1 )At the conclusion of a course

2 )A decision about performance 3 )Should follow formative feedback and remedial actions

4 )often given as learners’ grade

Evaluation

4 )The intent of a feedback session

• 5-10 minutes• Occurs frequently, in regular work activities• ‘I’d like to give• you some pointers about another way to

examine the spleen’.

1) Brief ongoing

• It is scheduled in advanced• 10-30 minutes• Address teacher observation over a period

of time• allows for improvement prior to the

summative evaluation.

2) Formal midcourse

• Summative assessment should be accompanied by feedback, reflection, and mentoring to help the learner improve.

3) End-of-course

5 )Why is feedback importantEricsson(2004): “acquisition of expert performance requires engaging in deliberate practice” and that “continued deliberate practice is necessary for maintenance of many types of professional performance”.

Feedback is an essential component of the deliberate practice concept.In Ericsson’s framework, the following conditions lead to improvementthrough deliberate practice:• Well-defined tasks or objectives• Detailed and immediate feedback on performance• Opportunities to improve by performing the sameor similar tasks repeatedly.

5 )Why is feedback important• Feedback plays a critical role for :1) Learner2) Teacher3) Program

5 )Why is feedback important (learner)

1) achieve course or program goals2) Reinforce good performance3) Provide basis for correcting mistakes4) Serves as a reference point for

summative assessment*Learners value teachers who facilitate their learning by giving constructive feedback that is adapted to their professional needs.

5 )Why is feedback important (learner) Negativ

e feedbac

kPublic humiliationComments

about personality

One way discussionLack of

personal interest in the learnerToo general

feedbackToo brief or

too long

Positive feedback

Active listening

Mutual respectSpecific praise or criticismDesire to helpSpending adequate time

5 )Why is feedback important (teacher)

• It is a critical component of a teacher’s role. Feedback links teaching and assessment of the learner’s performance

• demonstrates the teacher’s commitment to help the learner achieve course or program goals.

• Most teachers recognize the importance of feedback but find it difficult to do

• When they are asked to suggest specific educational training activities that they would find useful, most teachers say they would like to have help with feedback.

5 )Why is feedback important (program)

• Making feedback a regular part of the educational

experience encourages the development of expertise

• A culture that accepts and promotes feedback supports a feeling of positive improvement in the school or training program.

5) Why is feedback importantIn the United States and Canada, the agency with responsibility for the accreditation of medical schools, the Liaison Committee on Medical Education(LCME), establishes standards for the structure and function of the school: “Each student in a medical education program should be assessed and provided with formal feedback early enough during each required course or clerkship… to allow sufficient time for remediation.”LCME Standard ED31 2011 In the UK, the General Medical Council (GMC) plays an important role in defining educational standards: “Students must receive regular information about their development and progress. This should include feedback on both formative and summative assessments.”General Medical Council 2009

6 )Difficulties of giving feedback1. Time and place2. Knowledge base3. Ability4. Affective factors( poor rapport, concern about

the effect of negative feedback on the learner ( Ende (1983) )

5. Different perceptions about feedback6. The culture

Consequence

“Without feedback, mistakes go uncorrected,good performance is not reinforced, and clinicalcompetence is achieved empirically or not at all.The sense of being adrift in a strange environmentis amplified and learners may ‘generatetheir own feedback by attaching inappropriate

importance to internal and external cues”.’Ende 1983

7 )Principles of effective feedback

1. A culture that values constructive improvement.2. Attention to time and location.3. Use of standards4. First-hand observation5. Use of positive communication strategies6. Awareness of the ‘process’ of the encounter7. Use of ‘I’ statements8. Encouraging reflection9. Keeping cool10. Giving positive feedback, too11. Focusing on decisions and actions

7.1 )A culture that values constructive improvementBoth learner and teacher should expect

feedback to be a regular and frequent occurrence

outset it should be clear that they will work together toward a common goal of improving performance.

Providing feedback about the course and instructors should be an expected responsibility of learners.

7.5 )Use of positive communication strategies

1. Communicating effectively (active listening, ask open-ended reflective facilitating questions)

2. Making it a two way process3. Using precise, descriptive and objective

language. ( the information should be non-evaluative, specific, contain real examples ) “Your history was complete and you showed a concern for Mr Wench’s struggle with his weight” is preferable to “You did a great job!”

4. Focusing on the behavior, not the person.5. Monitoring the learner’s background,

temperament, personality and response6. Being selective

7.6 )Awareness of the ‘process’ of the encounter

Body language The tone of your voice Subtle evidence of judgment in words

7.11 )focusing on decision and actionsFeedback should provide insights and guide future performance.Concentrate on actions with specific examples.“What are the options for evaluating MrYonge’s injury? Have you considered doing anMRI?”

8 )Template for effective feedback sessions1. Prepare in advance2. Make the feedback session interactive3. Respond to a defensive interaction4. Reflect

8.1 )prepare in advance

1. Collect data2. Know what to look for

(For example, when observing an interaction with a patient, notice the learner’s respect for the patient’s privacy and comfort. When listening to a presentation, consider the learner’s organization, thoroughness and ability to identify and interpret changes)

3. Write it down4. Invite the learner to the feedback session5. Explain the purpose of the session and suggest

that it would be useful to reflect on the learner’s performance in preparation

8.2 )Make the feedback session interactive 1. Review the purpose of the session. Call it

feedback. Explain the distinction between feedback and summative assessment and label the purpose of the session

2. Get agreement on goals.3. Invite the learner to self-assess.

What aspects of your meeting with Ms Symme do you think went well? Which ones can be improved? Have you seen patients like this before?’

4. Listen actively to the learner’s response.5. Respond.

8.2 )Make the feedback session interactive 1) Begin by acknowledging and reinforcing positive behaviours

2) Correct when necessary. : ‘When you did/said that, I was concerned because…’ is more helpful than a general statement like, ‘Your work is not up to par.’

3 )Offer specific constructive suggestions for improvement: If the learner made an error, tell him or her how to do it right. ‘Let me show you how to examine the head and neck’.

6. Confirm the learner’s understanding.7. Conclude with actions ( invite the learner to generate ideas, modify the learner’s statement, summarize the meeting, set a timeline for the plan and a follow up feedback session)

8.3 )Respond to a defensive interaction

1. Identify and explore the issues.2. Keep a positive focus.3. Ask the learner to own part of the

problem.4. Negotiate and ask the learner to take

responsibility5. Offer time out

8.4 )reflect

Reflecting on your feedback session can create helpful insights that will strengthen your feedback skills.o What went well? What techniques seemedeffective?o What can you do differently next time?o What are your strategies for future feedbacksessions?

9 )Other approaches

1. ChecklistsClay et al (2007) reported the successful use of checklists to provide formative feedback and foster reflection.• The house officers checklist project• the checklists enabled the house officer to compare performance

against a ‘gold standard’ and enabled a ‘high-fidelity’ learning experience based on actual patient encounters.

2. computer-based feedback• All groups showed improvement from pre- to post-test. However,

only the group that received verbal feedback from an expert teacher showed lasting improvement

9 )Other approaches

3. Peer feedback

Feedback from peers is being used more frequently.Gukas et al (2008) studied student views of feedback from persons in their anatomy student-selected study module. Most students were comfortable giving and receiving feedback, and their attitudes towards peer feedback were generally positive.

10 )Training faculty to give feedback

Faculty training should address 2 areas: 1) Improving feedback skills2) Change the culture that underlies the

application of those skills They advocate a culture that supports giving and receiving both positive and negative feedback, regardless of the position of the person in the hierarchy

10 )Training faculty to give feedback

The feedback skills described in this chapter can involve a wide range of individual and group activities: 1. Ongoing reflection by the teacher after feedback sessions 2. Review of learner evaluations about feedback practices with

a skilled educator to help interpret the results and suggest new strategies Workshops that provide opportunities to practice and build skills

3. Longer in-depth Programs that feature immersion4. Peer coaching programs in which more experienced

colleagues provide assistance5. Small-group discussions.

Thanks for your kind attention

Giving Feedback. chapter 40. A practical guide for medical teachers. Harden

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Transcript of Giving Feedback. chapter 40. A practical guide for medical teachers. Harden