Giving Verbal Feedback and How to Receive the Responses - - PowerPoint PPT Presentation
Giving Verbal Feedback and How to Receive the Responses Association for Surgical Education Committees: Graduate Surgical Education Faculty Development Assessment and Evaluation Simulation Adopted with modification from: Nancy Schindler
Association for Surgical Education Committees:
Graduate Surgical Education Faculty Development Assessment and Evaluation Simulation
Adopted with modification from:
Nancy Schindler MD MHPE FACS, Hilary Sanfey MB BCh FACS, Steve Evans MD FACS
Introductions and learning objectives 1:10-1:15 Definition and importance of feedback 1:15-1:25 Elements of effective feedback, including practical tools 1:25-1:35 Challenges of verbal feedback and responding to learner reactions 1:35-1:45 OSTE feedback scenarios 1:45-2:25 Implementation at home 2:25-2:35 Evaluation and conclusion 2:35-2:40
Define the purpose of providing feedback Describe 5 steps in giving effective feedback Demonstrate effective feedback techniques
Saedon H et al. BMC Medical Education 2012;12:25. Trehan A et al. BMJ Open 2015;5:e006759. Hayes V et al. Perspect Med Educ 2017;6:319-324.
Min H et al. Surgery 2015;158:1168-1191.
McQueen SA et al. Am J Surg 2016;211:464-475; Mitchell JD and Jones SB. Int Anesth Clin 2016;54:54-65.
Bing-You R et al. Acad Med 2018;93:657-663.
Source Recipient Message Timing/ Delivery Action Plan
Source
Credible Trustworthy Knowledgeable
Recipient
Self esteem Mindset
Message
Positive versus negative feedback Accuracy: supporting evidence or examples Feedback sandwich
As giver of feedback, is my true intent to help them improve?
As close to the event as possible Longer delays reduce effectiveness but may
Emergencies may preclude (or necessitate)
immediate feedback
Examples
Informal
Teachable or “feedback” moments Usually verbal
Formal
Provided during scheduled sessions Verbal or written
Create a supportive learning environment and
Base feedback on observations
Encourage self-reflection Make a specific plan of action and follow up
“I am going to give you Feedback now”
Respond to the learner’s reaction
Start a dated, written record Needs to be practical, sustainable
Keep a trainee “file”: add regularly “File”: Paper, electronic, index cards, note pad,
Smartphone, dictate, calendar
Specifics: critical!
give examples (good & bad) – a FEW
Focus: behaviors & outcomes rather than attitudes Reports from others: document but be circumspect
Easy? Must reinforce good actions and behavior
Learners not always aware, especially novices
Be specific!
Personality issue vs. real problem
Be up front about your expectations at the beginning Talk with colleagues – is it just you?
Unless it’s critical, frame the issue and rehearse
the conversation
May mean feedback in a few hours or next day
“Feedback Sandwich”… maybe
Start with learner’s perspective
Present from “I want you to be the best doctor
you can be”
Be prepared for any response
Tears Passive Defensive Angry Surprised
Don’t back down: firmly but gently stay on point
Action plan
How do we fix this? By when do you expect improvement?
Record the exchange
Serious enough to give heads-up to higher level
supervisor?
Follow-up at appointed time Mention response to feedback in final
evaluation
Frequent oral feedback
(Say: “I’m going to give you…”!!) in time for correction
Sit down if feedback is important or negative Document specific actions & behaviors, +/- Summative comments: will upper-level
supervisor get an accurate picture?
Negative is hard, but you’re the Mom! (or Dad!)
Divide into groups of 3-4
Standardized learner will rotate through groups Decide who will go first as “teacher” Others will observe and give FEEDBACK to the teacher
Teacher reads the scenario then holds a feedback
session (10 min)
Follow guidelines for feedback (5-6 min)
Orient the learner
Provide feedback
Develop a specific follow-up plan
Debrief: (4-5 min)
Observers and learner give feedback on feedback
Use the Observer Evaluation Form Repeat with new teacher and learner scenario (x3-4) Return for group discussion
Create a supportive learning environment and
Base feedback on observations
Encourage self-reflection Make a specific plan of action and follow up
“I am going to give you Feedback now”
Respond to the learner’s reaction
What was the most challenging part of the
teacher role?
What was the easiest? Did the teacher orient the learner using the word
“feedback”?
How did the teacher respond to the learner’s
reaction?
What was the learner’s feedback vs. the
Identify Stakeholders
Learners: Faculty, Fellows, Residents, Students Program / Clerkship Director Institution
Obtain resources
Learner time Space (groups need some separation) Materials: Scenarios, Framework Facilitators Standardized Learners (SLs) Cost: minimal unless you pay SLs
Role play vs. Standardized learners
Who?
MS4 (not MS3), lab residents, other specialty
residents or faculty, professional actors
Look for those interested in education
Training?
Minimal needed to play the role Helpful if you can train them to facilitate
Compensation?
Credit, Starbucks card, offer to help other group
(Zero level checklist for PBLI 2 Milestone)
– 2 groups of: 1 faculty facilitator, 2 interns, and one standardized learner (SL) – Total need: 3 faculty, 3 SLs
Room 1 Room 2 Room 3 20 min F1, Intern 1 and 2 SL 1 F2, Intern 3 and 4 SL 2 F3, Intern 5 and 6 SL 3 20 min F1, Intern 1 and 2 SL 3 F2, Intern 3 and 4 SL 1 F3, Intern 5 and 6 SL 2
– Principles of Effective Feedback: 20 min – OSTE: 60 min – Recap and key learning discussion: 10 min
Group 1 Group 2 Group 3 Group 4 Group 5 10 min 5 min Faculty 1 SL 1 Feedback Faculty 5 SL 2 Feedback Faculty 9 SL 3 Feedback Faculty 13 SL 4 Feedback Faculty 17 SL 5 Feedback 10 min 5 min Faculty 2 SL 2 Feedback Faculty 6 SL 3 Feedback Faculty 10 SL 4 Feedback Faculty 14 SL 5 Feedback Faculty 18 SL 1 Feedback 10 min 5 min Faculty 3 SL 3 Feedback Faculty 7 SL 4 Feedback Faculty 11 SL 5 Feedback Faculty 15 SL 1 Feedback Faculty 19 SL 2 Feedback 10 min 5 min Faculty 4 SL 4 Feedback Faculty 8 SL 5 Feedback Faculty 12 SL 1 Feedback Faculty 15 SL 2 Feedback Faculty 20 SL 3 Feedback
Effective feedback requires collaboration
between teacher and learner
Self-appraisal followed by discussion is better
than top-down feedback
Consistency of feedback improves perception of
accuracy
Avoid negative feedback in front of peers or
patients
Always end with encouragement and a plan
Frequent/Accurate/Specific/Timely
Michael Hulme
mhulme@wakehealth.edu
Megan Miller megan.miller431@gmail.com John Paige
JPaige@lsuhsc.edu
Barb Pettitt
barbara.pettitt@emory.edu
Jim Rucinski
jar9008@nyp.org
Nancy Schindler
NSchindler@northshore.org
Saedon H et al. The role of feedback in improving the effectiveness
Educ 2012;12-25
Trehan A et al. The impact of feedback of intraoperative technical performance in surgery: a systematic review. BMJ Open 2015;5:e006759
Hayes V et al. Is feedback to medical learners associated with characteristics of improved patient care? Perspect Med Educ 2017;6:319-324
Min H et al. Systematic review of coaching to enhance surgeons'
McQueen SA et al. Examining the barriers to meaningful assessment and feedback in medical training. Am J Surg 2016;211:464-475
Mitchell JD and Jones SB. Faculty Development in Feedback
Bing-You R et al. The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher–Learner Feedback
Sachdeva A. Use of effective feedback to facilitate adult learning. Journal of Cancer Education 1996;11:106-118
Salermo et al. Faculty development seminars based on the one minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med 2002;17:779-787
Schartel SA. Giving feedback- an integral part of education. Best Pract Res Clin Anaesthesiol 2012; 26:77-87
Spickard A. Words hard to say and hard to hear: May I give you some feedback? J Gen Intern Med 1998;13:142-143
Michael Hulme
mhulme@wakehealth.edu
Megan Miller megan.miller431@gmail.com John Paige
JPaige@lsuhsc.edu
Barb Pettitt
barbara.pettitt@emory.edu
Jim Rucinski
jar9008@nyp.org
Nancy Schindler
NSchindler@northshore.org