How to Give High Quality Feedback Greg Simons Associate GP Dean Oxford PGMDE 14 November 2012
Overview of Presentation � Why Feedback � Timing � Technique � Work through scenario � If time allows… Pitfalls
Feedback Information about performance or behaviour that leads to action to affirm or develop that performance or behaviour.
Why is feedback important? � Identify current strengths and weaknesses � Identify future learning and development needs � Helps develop capacity to critically evaluate own and others’ performance
Motivational Feedback “the difference between a lady and a flower girl is not how she behaves, but how she's treated. I shall always be a flower girl to Professor Higgins, …but I know I can be a lady to you because you always treat me as a lady.” The Pygmalion effect
Factors that affect motivation in tasks • Clear about what is expected • Supported by managers or supervisors • Recognised for their efforts • Contributing in a way which is positive and recognisable • Free to express their views and ideas • Challenged in a way which helps them to develop and be more creative
Good Feedback Specific � Timely � Balanced � Based on observed facts � Non-judgemental � Promotes reflection � Results in an action plan � (Norcini and Burch 2007)
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan avoid personal comments BAD: “you fool! Can’t you remember that I needed these accounts for the meeting yesterday?” • GOOD: “Shirley, I need the accounts for 2pm on Friday for the management meeting later in the • afternoon.” avoid mixed messages BAD: “John, you always look as if you have just got out of bed (but your work is good on the whole) • GOOD: “John, I would like you to take more care with your appearance in order to make a better • impression” avoid diffusion BAD: “Some of you are not achieving your performance goals. You have to improve.” • GOOD: “Richard, you have not achieved your performance goals this week. Can we talk about it & • work out some plans to improve?”
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action Plan say it while it's fresh; don't wait until a long time after the event.
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan � All feedback is positive in that it is designed to aid learning. � Avoid that ‘BUT’!! � ‘and..’ works better
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan i.e. concrete examples; based on behaviour not personality � BAD: "I think you’re selfish in that you don’t listen to anyone else". � GOOD: "I notice that you don’t look at people when they are talking to you".
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan � Ask for the trainees take on the evidence; what he or she could do to improve � Overtly let them know you support them. Motivational feedback before formative .
Specific Timely Balanced Based on observed facts Non-Judgemental Promotes reflection Results in Action plan � Prioritise your feedback - don't overload the receiver � Summarise what the learner has identified as action to be taken � Encourage; get them to focus on positive outcomes and therefore, a much easier and better future.
Time for a Task � Using the principles of good feedback discuss in groups of three how you would go about giving this young Doctor some feedback? (10 Mins) � Be prepared to explain your solution to the group.
Scenario � You have a young female FY1 just allocated to your service and meet her for the first time on your ward. You notice she is wearing a very short skirt and a revealing top both of which are entirely inappropriate. How would you give her feedback?
Scenario � You have had a written complaint from a patient about your registrar’s attitude. The patient found him rude and arrogant. You have also has some informal feedback from the nursing staff which is similar. He is otherwise a very capable clinician, ambitious and dedicated. How would you give this feedback?
Scenario � You are the Clinical supervisor of a female SHO. You have become aware she has developed a relationship with another SHO from another service working in a different part of the hospital. You have received some complaints from the nursing staff that she has been seen passionately embracing the other SHO in a side room on your ward just prior to your ward round.
Good Feedback Specific � Timely � Balanced � Based on observed facts � Non-judgemental � Promotes reflection � Results in an action plan � (Norcini and Burch 2007)
Skills of effective feedback Generic communication skills; LISTEN and ASK. We have two ears and one mouth! Try to make the trainee think! Balance of challenge and support
Daloz’s Support-Challenge Grid [ Daloz LA. Effective Teaching and mentorship: realizing the transformational power of adult learning experiences Fransisco. CA. Jossey-Bass, 1986 ] High Challenge Full Support Trainee grows through Trainee withdraws from monitoring development of new knowledge relationships and images No Growth possible Low Challenge No Support Trainee becomes confirmed in Trainee is not encouraged to consider or reflect on knowledge and images pre-existing images and ideas
Defensive positions to avoid King; BMJ 1999; 318 : S2-7200 � Obligation � Moral high ground � Burying and fudging � Minimising � Colluding
Another Task if there is time � There have been several complaints from the nursing staff about the poor personal hygiene of your latest Registrar- particularly his body odour! How would you give him this feedback?
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