Residents as TeachersLoyola University Medical Center

Stritch School of Medicine

Graduate Medical Education

Session 2

The Fine Art of Feedback

Intended Learning Outcomes

Describe giving, receiving, and soliciting feedback in more detail

Explain the interactions between giving, receiving, and soliciting feedback

Identify barriers that prevent effective feedback

Learn advanced techniques for giving, receiving, and soliciting feedback

How do you know you’re doing a good job?• “When you don’t call me into your office, I must be

doing a good job.”• “I must be doing okay because there haven’t been

any speeches about patient safety lately.”• “I must be doing okay because you always tell me

when I make too many errors.”• “When you don’t send my reports back, I know I’m

doing a good job.”• “When you don’t look at me and shake your head, I

know I’m doing a good job.”

Giving Feedback

Receiving

Feedback

Soliciting

Feedback

“Lip service”

“Demotivation”

“Justification”

Feedback Triad

Why Use Feedback?

• Learners who get effective feedback:– do significantly better– develop better judgment– learn faster

• Learners rate feedback as one of the most important qualities of a good teacher

• Most learners want more feedback on their clinical skills

• Feedback helps everyone

Arts & Crafts

What is the main reason you do not get feedback more often?

How do you typically react when receiving feedback?

What’s the main reason why you don’t solicit feedback more often?

First, teachers need to undertake effective instruction…

…Feedback is what happens second

Before Giving Feedback

Have you communicated your expectations?

Have you asked how the learner wants to get feedback?

Have you conducted an orientation?

Have you probed learner’s knowledge, skills, and abilities?

Have you checked learner’s experience?

Two Types of Feedback

• Informal– Spontaneous– Unplanned– Brief

• Formal– Scheduled– Planned– More time

Feedback Triad

Giving Feedback

Receiving Feedback

Soliciting Feedback

Definition of Giving Feedback

Specific information provided by another source with the intent to improve performance or understanding

The art of observation (of actions) and description (of outcomes)

Activity

• Think about the most recent time you received feedback from a teacher

What was the event/situation?

What specifically did they tell you?

How did you take it?

• Write your answers on the

index card provided

Levels of Giving Feedback

TASK How well tasks are understood and/or performed

ProcessThe main process needed to understand and/or perform tasks

Self-Regulation

Self-monitoring, directing, and regulating of actions

SelfPersonal evaluations and affect (usually positive) about the learner

Feedback Techniques

Ask learner how she/he wants feedback

Based on direct observation

Ask learner for focused self-assessment

Describe what you saw

Feedback Techniques

Make the feedback very focused• Specific behavior amenable to change

• Effectiveness/outcomes of behaviors

• Actions not inferences

• Value to receiver

Develop joint action plan

Follow-up

ActivityFind a partner

30 seconds to:Think of something you like about your partner’s outfit

One way the outfit could be improved

Each partner tells what you like about the outfit, then says “but” then tell how the outfit could be improved

Now repeat what you just said to your partner with the word “and” instead of “but”

Formal or Corrective Feedback

Think it through firstControl your emotions

Anticipate reaction

Private settings

Explain the reason for the feedbackFocus on actions/behaviors

Supported by objective examples and direct observation

Stay calm, use conversation voice

Formal or Corrective Feedback

Actively listen to responses

Clarify any misunderstandings

Plan to move forward

“Giving” Review

Set a good foundationTeaching, expectations, orientation

Focus the feedback

Learner self-assessment

Describe what you saw

Going forward

Where am I going?

How am I doing?

Where to next?

Feedback TriadGiving Feedback

Receiving Feedback

Soliciting Feedback

Information Sender

ReceiverEnvironment

• Timely• Video/Written/ Verbal• Goal – oriented• Specific• Descriptive• Action plan

• Credibility• Characteristics• Behavior• Delivery• Respect• Expertise• Direct observation• Objective

• Mentally ready• Fits goals/objectives• Useful• Personal health• Self-perception• Prior KSA• Motivation

PerceptionFilter

• Private/Public• Outpatient/Inpatient/OR• Individual/Group

Receiving Feedback

Activity

Need a volunteer

WarningNo physical strain or pain

May be mental anguish or feelings of resentment

Effects won’t last more than 10 minutes

Receiving Feedback

Will it help you obtain your goal?

Listen to everything said—don’t interrupt

Don’t defend, contradict, argue, or interrogate

Ask for clarification if needed

Accept it as one bit of data

Feedback TriadGiving Feedback

Receiving Feedback

Soliciting

Feedback

Feedback Rich Environment

Mutual accountability

Willingness to learn

No fear

No surprises

Truthfulness

Self-responsible language

Coaching

Soliciting Feedback: Receiver

Request feedback early

Highlight exactly what you are looking for

Choose specific people

Make sure it is directly related to your goals

Use helpful opening phrases (“I think I missed the patient’s reaction. What do you think?”)

Ask for recommendations

Never compare the feedback from others openly

Thank them for the information

Decide what to do with their input

Consider it as a single data point

If you do use the feedback, tell them

Soliciting Feedback: Sender

Create a supportive atmosphere

Realize the person is asking for guidance, not criticism

Clarify what the person wants feedback on

Listen to their self-assessment and respond accordingly

When finished, ask if that was what they wanted to know

Respond with respect

Help the person create an action plan: don’t tell them what to do

Follow up in the future

Barriers to Giving Feedback

“The learners already know how they’re doing.”

“I don’t have time.”

“That must have been an anomaly.”

“I’m not used to this. I feel awkward.”

“Learners get defensive.”

“The learner isn’t ready to receive feedback.”

“Who/what do I compare them to?”

Take Home Points

Giving FeedbackTeach first

Be focused

Receiving FeedbackActive listening

A single data point

Soliciting FeedbackAsk specifically

Ask when you’re ready to receive