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 MD MHPE FACS, Hilary Sanfey MB BCh FACS, Steve Evans MD FACS

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Session Agenda 1:10-1:15 Introductions and learning objectives 1:15-1:25 Definition and importance of feedback Elements of effective feedback, 1:25-1:35 including practical tools Challenges of verbal feedback and 1:35-1:45 responding to learner reactions 1:45-2:25 OSTE feedback scenarios 2:25-2:35 Implementation at home 2:35-2:40 Evaluation and conclusion

Learning Objectives Upon completion of this session, participants will be able to:  Define the purpose of providing feedback  Describe 5 steps in giving effective feedback  Demonstrate effective feedback techniques

What is feedback?

Feedback Interactive process aimed at reinforcing positive behavior and providing specific guidelines for modifying future behavior

Why Is Feedback Important?

FEEDBACK BENEFITS Trehan A et al. BMJ Open 2015;5:e006759. Hayes V et al. Perspect Med Educ 2017;6:319-324. Saedon H et al. BMC Medical Education 2012;12:25.

FEEDBACK BENEFITS Min H et al. Surgery 2015;158:1168-1191.

FEEDBACK OBSTACLES

FEEDBACK OBSTACLES McQueen SA et al. Am J Surg 2016;211:464-475; Mitchell JD and Jones SB. Int Anesth Clin 2016;54:54-65.

FEEDBACK OBSTACLES Bing-You R et al. Acad Med 2018;93:657-663.

Principles of Effective Feedback

Can you share a positive (or negative) feedback experience?

What are the critical elements in a feedback encounter?  Source  Recipient  Message  Timing/ Delivery  Action Plan

Effectiveness influenced by:  Source  Credible  Trustworthy As giver of feedback,  Knowledgeable is my true intent to help them improve?  Recipient  Self esteem  Mindset  Message  Positive versus negative feedback  Accuracy: supporting evidence or examples  Feedback sandwich

Timing: Is There A “Right Time” ?  As close to the event as possible  Longer delays reduce effectiveness but may be beneficial if the student/resident (or faculty member!) is upset  Emergencies may preclude (or necessitate) immediate feedback  Examples

Feedback Strategies

Feedback Methods  Informal  Teachable or “feedback” moments  Usually verbal  Formal  Provided during scheduled sessions  Verbal or written

Feedback Guidelines FAST Frequent/Accurate/Specific/Timely

Tips for an Effective Feedback Session Create a supportive learning environment and orient the learner to the focus of the session “I am going to give you Encourage self-reflection Feedback now” Base feedback on observations • Be specific! • Focus on behaviors Respond to the learner’s reaction Make a specific plan of action and follow up

Responding to the Learner’s Reaction

Documentation of Trainee Performance  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

Positive feedback  Easy?  Must reinforce good actions and behavior  Learners not always aware, especially novices  Be specific!

Negative feedback  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

Negative feedback  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

Negative feedback  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

Summary and Tips  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!)

Feedback Scenarios

 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

Tips for an Effective Feedback Session Create a supportive learning environment and orient the learner to the focus of the session “I am going to give you Encourage self-reflection Feedback now” Base feedback on observations • Be specific! • Focus on behaviors Respond to the learner’s reaction Make a specific plan of action and follow up

Group Debrief  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 observer’s feedback?

Implementation at Home

Implementation  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

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

Plan 1: Intern Orientation for six interns (Zero level checklist for PBLI 2 Milestone) • One hour session – 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 F2, Intern 3 and 4 F3, Intern 5 and 6 SL 1 SL 2 SL 3 20 min F1, Intern 1 and 2 F2, Intern 3 and 4 F3, Intern 5 and 6 SL 3 SL 1 SL 2

Plan 2: Faculty Development for 20 faculty • 90 minute session – Principles of Effective Feedback: 20 min – OSTE: 60 min – Recap and key learning discussion: 10 min • 5 groups of: 4 faculty learners and one SL (rotating facilitator) • Total need: 2 facilitators and 5 standardized learners Group 1 Group 2 Group 3 Group 4 Group 5 10 min Faculty 1 Faculty 5 Faculty 9 Faculty 13 Faculty 17 SL 1 SL 2 SL 3 SL 4 SL 5 5 min Feedback Feedback Feedback Feedback Feedback 10 min Faculty 2 Faculty 6 Faculty 10 Faculty 14 Faculty 18 SL 2 SL 3 SL 4 SL 5 SL 1 5 min Feedback Feedback Feedback Feedback Feedback 10 min Faculty 3 Faculty 7 Faculty 11 Faculty 15 Faculty 19 SL 3 SL 4 SL 5 SL 1 SL 2 5 min Feedback Feedback Feedback Feedback Feedback 10 min Faculty 4 Faculty 8 Faculty 12 Faculty 15 Faculty 20 SL 4 SL 5 SL 1 SL 2 SL 3 5 min Feedback Feedback Feedback Feedback Feedback

Summary  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

Feedback is a skill we can all learn and improve!

Remember FAST! Frequent/Accurate/Specific/Timely

Questions?

Workshop Evaluation https://redcap.wakehealth.edu/re dcap/surveys/?s=TRPJWNYK8C

Workshop Faculty Contact Information  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