Reduced to tears and triggering defense

mechanisms:

How to provide effective, meaningful verbal feedback and

create learning opportunities 

Leah Delfinado, MDAssociate Program Director

Department of Obstetrics and GynecologyAdvocate Illinois Masonic Medical Center

No disclosures

Qui tacet consentit

Objectives•Why feedback is important•Types of feedback•Barriers to giving and receiving feedback•What does meaningful feedback look like•Practice makes perfect

Why feedback is importantCritical assessment toolEmphasizes reflective capacityFosters professional autonomy

Informal vs Formal Assessment

   Barriers to giving feedback•Fear of upsetting the trainee•Trainee is resistant or defensive

Barriers to Receiving Feedback•Feedback is too generalized and not related to

specific observations•Feedback does not give guidance to rectify the

behavior•Inconsistent feedback from multiple sources•Lack of respect for the source of feedback

Giving Effective Feedback•Immediate•Private•Interactive•Behavior focused, not personality based

• Present behaviors, not old ones• Give examples• Don’t assume motive• Offer alternate behaviors

Giving effective feedback•Consider your message; 2-3 key points•Consider the impact•Focusing on overall learning and development within

residency, keeps the overall message positive•“Sandwiching” information often feels disingenuous

Giving Effective Feedback•Encourage self reflection• “What do you think you did well?”• “What do you think you can improve upon?”

• May be particularly effective for those trainees you view as defensive

Scenario 125yo G1P0 GDM, with poor labor curve delivers a 4200g infant with a 1 minute dystocia at 1am. The PGY 1 pushed with the patient for 90 minutes in the room by herself then called the attending physician when the patient was crowning. The attending took over (when the intern failed to perform any maneuvers) performing a Woods screw with McRoberts and suprapubic pressure.

What feedback would you really

like to give?Person A is a senior resident, comfortable with

and often asks for feedback. Person B is an intern, clearly uncomfortable with feedback and self conscious with your

supervision of their performance.

Scenario 2You’re assisting a resident with a speculum exam and pelvic exam on a 21yo nullip for her first gynecological visit. You notice the patient is extremely nervous, and she has a hard time tolerating the exam. The resident has 3 other patients waiting at the clinic, hurries through the exam with little communication, and the patient appears to be upset afterwards. The resident leaves the room without addressing the patient’s distress.

Feedback?Person A is someone you’ve given feedback to

in the past, and they appeared defensive.Person B is a junior resident who has already

been given feedback today by their senior resident, and that exchange ended in tears.

Goals of Effective FeedbackMotivateDevelop knowledge, skills, behaviorsMaximize potentialRaise awareness of strengths and weaknessesIdentify techniques to improve

Questions, Comments...

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