The University of Mississippi T O O L S T O P R O V I D I N G E F - - PowerPoint PPT Presentation

T O O L S T O P R O V I D I N G E F F E C T I V E F E E D B A C K P R O F E S S O R A N D C H A I R D E P A R T M E N T O F P H A R M A C Y P R A C T I C E S E E N A L . H A I N E S , P H A R M D , B C A C P , F A S H P , F A P H A , B C - A D M A P R I L 1 3 , 2 0 1 6

The University of Mississippi

Learning Objectives

1.

Define types of tools to assess learners.

2.

Describe effective techniques for evaluating learners.

3.

List barriers and benefits to providing constructive feedback at various points throughout the evaluation period.

4.

Discuss skills that reduce one’s own resistance to feedback.

5.

Deliver nonjudgmental feedback in role-play scenarios.

6.

Describe characteristics of constructive feedback and how to deliver it effectively.

Ponder for a Moment…

Do you believe your learners 'different' today? What’s the first word that comes to mind when you hear…

• ‘Millenials’?
• “Gen Zs”
• What are the challenges of clinical teaching

today that didn't exist 5-10 years ago?

Learner Generations

Comparing the Generations

https:/ / www.knoll.com/ knollnewsdetail/ what-comes-after-y-generation-z-arriving-to-the-office-soon

Generation Y vs. Z

What Does All This Mean?

• We may…

.

Have to approach our non-negotiable(s) as

developmental (develop a culture of learner

responsibility)

Have to model problem solving / critical

thinking skills vs. instant answers

Have to provide more structure (frequent feedback /

encouragement)

Have to value collaboration

• Av oid la beling…

refocus our role as an educator and make it a win-win situation

Key Readings

WHAT: Key Readings

http:/ / www.open.ac.uk/ opencetl/ resources/ pbpl-resources/ finlay-l- 2008-reflecting-reflective-practice-pbpl-paper-52

• The experience itself
• Thinking about it during the

event

• Deciding how to act at the

time

• Acting immediately

Reflection in Action

(at time of event)

• Reflecting on something that

has happened

• Thinking about what you might

do differently if it happened again

• New information gained used

to process feeling and actions

Reflection

• n Action

(after event)

Professionalism, Communication Skills, Knowledge, Confidence

Key Reading

Learning Style Inventory

VARK

http:/ / vark-learn.com/ the-vark-questionnaire/

http:/ / learningfromexperience.com/ tools/ kolb-learning-style-inventory-lsi/ http:/ / lsibba310.weebly.com/ introduction-to-kolb-learning-style- inventory.html

Learning Style Inventory

Kolb or HPILS

Strengthsfinder Inventory

Review: Malcolm Knowles Theory of Andragogy

http:/ / www.quora.com/ What-are-some-of-the-greatest-educational-theories-methodologies-

• f-all-time

Lecturer

Self-Directed Facilitator

Value-Driven Content

http:/ / www.quora.com/ What-are-some-of-the-greatest-educational-theories-methodologies-of-all-time

 The lea rner’s self-concep t

Adults have self-responsibility and have the capacity to make decisions for themselves

 The role of lea rner’s exp erience

Adults have a range of life experiences

 Rea d iness to lea rn

Resulting from realization of the need to learn

 Orienta tion to lea rning

Adults are m otiv a ted (usually intrinsically motivated) to learn because they are able to realize the worth / value

Critical Thinking

IDEA Paper No. 37

Fostering Critical Thinking

Handout

Fostering Significant Learning

Assessing Learners in Clinical Environm ent

Based on work by Miller GE, The Assessment of Clinical Skills/ Competence/ Performance; Acad.Med. 1990; 65(9); 63-67.

Reflection Model

http://distributedresearch.net/blog/2008/05/27/reflection-on-keeping-an-action-log-for-a-month

Mechanisms to Assist in Learning Experiences

http:/ / www.aspireconsulting.net/ learning-from-experience- blog/ bid/ 290936/ 10-Learning-Practices-Tools-for-Creating-Change

http:/ / www.exploringfamilies.com/ experiential-learning.html

Putting it All Together

Preceptor Models: Framework & Mnemonics

Facilitating Experiential Learning

http:/ / www.businessballs.com/ experiential_learning.htm

Learning New Skills & Techniques

http:/ / postgrad.familymed.ubc.ca/ resources/ resources-for-evaluating-residents/

Adapted from: Race P. Using Feedback to help students learn. The Higher Education Academy.

Conscious Com petence Student knows what they have done well Needs to focus on performance Caution for “faint praising” Conscious Incom petence Helping students learn and do what they cannot Recognizes the need to acquire it Move out of transit box Unconscious Incom petence What the student did not yet know what they could not do (not aware of skill in question) Out of danger box and into transit box Unconscious Com petent Things they are good at but do not realize Typically low confidence and self esteem OR can perform a task w/ o conscious thought

Learning New Skills & Techniques

(cont) 5 th stage can be reflective com petence

Feedback Defined

Information provided by an agent (teacher, peer, parent, self, experience) regarding one’s perform ance

• r understanding
• A consequence of performance
• Can be accepted, modified, or rejected

“Feedback is inform ation with which a learner can confirm , add to,

• verwrite, tune, or restructure inform ation in m em ory, whether

that inform ation is dom ain knowledge, m eta-cognitive knowledge, beliefs about self and tasks or cognitive tactics and strategies

• Winne and Butler (1994)

Evaluative (value judgm ent) OR Descriptive (what learner said, did and guide to im prove) Used by learner to reassess attainm ent of goals

Seven Principles of Good Feedback Practices

Goal-referenced Tangible and Transparent Actionable User friendly Tim ely Ongoing Consistent

Benefits and Challenges to Providing Effective Feedback

Benefits

 Congruence with learning

• bjectives / activities and
• utcomes

 Strengthens communication

between preceptor and learner

 No surprise with summative

assessments

 Modeling of reflective practices

and self-assessment

Challenges

 Lack of clear objectives &

expectations

 Teaching pitched at the wrong

level

 Focus on recall of facts rather

than problem solving

 Lack of active participation by

learners

 Inadequate direct observation of

learners and feedback

 Insufficient time for reflection and

discussion

Ramani S. AMEE Guide No. 34: Teaching in the Clinical Environment.

http://littlewhitecoats.blogspot.com/2011/02/the-microskills.html http://www.blogger.com/goog_1119974112

One Minute Preceptor Method

1. Get a commitment

• 2. Probe for supporting evidence
• 3. Teach general rules
• 4. Reinforce what was done right
• 5. Correct mistakes

Centra l Goa l Is to reduce discrepancies between current understandings and perform ance and a goal

Feedback Central Themes

 Must answer 3 m ajor questions asked by the

instructor and / or learner

1

Where am I going (what are the goals)?

2

How am I going (progress towards goal)?

3

Where to next (activities to make better progress)? FEED UP FEED FORWARD FEED BACK

Feedback Levels: Success Criteria

Level of Task Perform ance Level of Process Understanding Regulatory or Metacognitive Process Level Self or Personal Level

Feedback Model

Hattie J, Timperley H. The Power of Feedback. Review of Educational Research. http:/ / rer.sagepub.com/ content/ 77/ 1/ 81

Handout

Effective Feedback Attributes

http:/ / www.alvarezporter.com/ 2013/ 05/ throw-out-the-praise-sandwich/

Directly related to specific learning goals (LE) Be descriptive not judgmental Focus on task not the person Action plan to improve performance

Feedback Language

 Use 'I' messages...instead of "You didn't follow the protocol?”  Use descriptive language...instead of "You had great rapport

with your patient.”

 Avoid interpretation...instead of "You didn't check for

understanding.”

 Collaborate on an action plan...instead of "I want you to read

up on the protocol."

"I'm wondering why you didn't follow the protocol?" ”I saw you call the patient by nam e, and look directly at them as you spoke.” "When you were explaining the m edication, I noticed the patient's body language seem ed they were confused." "What actions will help you rem em ber the protocol?"

Preceptor Developm ent – Self Reflection

Buck B, Wilinson ST. Preceptor Development: Providing Effective Feedback, Part 2. Hosp Pharm. 2014;49(6):521-29. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062731/pdf/hpj-49-521.pdf

Handout

Productive or Nonproductive Com m ents

Buck B, Wilinson ST. Preceptor Development: Providing Effective Feedback, Part 2. Hosp Pharm. 2014;49(6):521-29. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062731/pdf/hpj-49-521.pdf

Pre-Rotation Feedback Checklist

Wilinson ST, et al. Preceptor Development: Providing Effective Feedback. Hosp Pharm. 2013 Jan;48(1):26-32. Available at: http:/ / www.ncbi.nlm.nih.gov/ pmc/ articles/ PMC3839441/ pdf/ hpj4801-26.pdf

Weekly feedback session with Likert Scale (1-4) (1 – Strongly Disagree; 2 – Disagree, 3 – Agree; 4-Strongly Agree

Pre-Rotation Feedback Checklist

Weekly feedback session with Likert Scale (1-4) (1 – Strongly Disagree; 2 – Disagree, 3 – Agree; 4-Strongly Agree

Wilinson ST, et al. Preceptor Development: Providing Effective Feedback. Hosp Pharm. 2013 Jan;48(1):26-32. Available at: http:/ / www.ncbi.nlm.nih.gov/ pmc/ articles/ PMC3839441/ pdf/ hpj4801-26.pdf

Pre-Rotation Feedback Checklist

Weekly feedback session with Likert Scale (1-4) (1 – Strongly Disagree; 2 – Disagree, 3 – Agree; 4-Strongly Agree

Wilinson ST, et al. Preceptor Development: Providing Effective Feedback. Hosp Pharm. 2013 Jan;48(1):26-32. Available at: http:/ / www.ncbi.nlm.nih.gov/ pmc/ articles/ PMC3839441/ pdf/ hpj4801-26.pdf

Pre-Rotation Feedback Checklist

Weekly feedback session with Likert Scale (1-4) (1 – Strongly Disagree; 2 – Disagree, 3 – Agree; 4-Strongly Agree

Wilinson ST, et al. Preceptor Development: Providing Effective Feedback. Hosp Pharm. 2013 Jan;48(1):26-32. Available at: http:/ / www.ncbi.nlm.nih.gov/ pmc/ articles/ PMC3839441/ pdf/ hpj4801-26.pdf

Difficult Learning Situations

• STOP before it occurs
• Set clear expectations
• Determine learner goals
• Reassess at midpoint

Prim ary Prevention

• DETECT looks for cues
• Don’t wait / TRIAGE
• Initiate SOAP early
• Give specific feedback and monitor

Secondary Prevention

• MANAGE effectively/ seek help
• IMPROVE

Tertiary Prevention

PREVENT DETECT MANAGE

When to involve to SOP??

Learner Differential Diagnosis

Cognitive Base Clinical Skills Com m unication Lack of Effort Anxiety, Depressi

• n,

Anger, Fear Relevance Illness Substance Abuse

Trainee in Crisis Troublesom e Learner Difficulty Trainee Disruptive Trainee

SOAPing A Challenging Learning Situation

Subjective What do others say or think? What is the “chief complaint”? Reflective activities and gathering information Objective Specific behaviors preceptor witnessed Assessment Cognitive, affective, valuative, environmental, medical Plan Considerations; do I need to gather more data? Do you need to intervene or get help? (RPD and Coordinator)

Mountain Valley AHEC Office of Regional Primary Care Education, Asheville, North Carolina, with support from HRSA Family Medicine Training Grant #1D15PE50119-01, a federal demonstration grant. Quirk, M. E. How to Teach and Learn in Medical School. Charles C. Thomas, Springfield, IL: 1994.

Interventional Approach

Oz Character Nature of Resident/ Student Deficiency Corrective Measures Scarecrow Com petence Instruct & Direct Build in structure Train and Guide Closely oversee Tinm an Com m itm ent Motivate & Inspire Explain rationale Em phasize im portance Provide incentive Cowardly Lion Confidence Encourage & Facilitate Dem onstrate support Praise effort Push com fort zone Dorothy No Deficiency Em power Clarify expectations Ensure resources

Adapted from: Connors R, et al. The Oz Principle, Paramus, NJ: Prentice Hall; 1994. Blanchard K, et al. Leadership and the One Minute

• Manager. New York: William Morrow & Co.; 1985. Hersey P, Blanchard K, Johnson DE.

Management of Organizational Behavior. Saddle River NJ: Prentice Hall; 1996.

Addressing Student PERFormance

PERF Level First Step Second Step Third Step Perception Student’s Perception YOUR perception Reach mutual understanding Expectation Your expectations Student’s understanding of Your expectations Mutual understanding of expectations Resolution Gaps between performance perceptions and expectations Identify root cause & corrective measures (Oz protocol) Explain action plan and document Student teach- back method Follow-Up Specific criteria for success Time-frame to assess criteria Assess criteria and discuss results

Adapted from: Connors R, et al. The Oz Principle, Paramus, NJ: Prentice Hall; 1994. Blanchard K, et al. Leadership and the One Minute

• Manager. New York: William Morrow & Co.; 1985. Hersey P, Blanchard K, Johnson DE.

Management of Organizational Behavior. Saddle River NJ: Prentice Hall; 1996.

Experiential Matrix Checklist

Assessm ent Criteria Measurem ent Contextual

• 1. Are materials appropriate and suited to course?
• 2. Is the main task and outcomes aligned with stated course objectives?

Participative

• 3. Does the learner play an active part in the task or problem(s)?

Holistic

• 4. Does the activity involve a cognitive dimension?
• 5. Does the activity involve interpersonal and other non-cognitive skill

building?

Interactive

• 6. Does the learner interact with other learners (layered learning?)
• 7. Does the learner interact with patients/ providers?

Realistic

• 8. What is the degree of authenticity?
• 9. Is there propensity for adversity and conflict?

Reflective

• 10. Does experience require abstract or reflection on success and failures?
• 11. Does discussion or other activities include stimulating questions for the

experience?

Adaptive

• 12. Is the learner encouraged to apply abstract or non-cognitive skills learned to

new problems?

• 13. Is the learner encouraged to apply new cognitive skills based on main task to

novel problems.

Remember…Effective Feedback Involves

Self- assessment Ends with an action plan Positive and constructiv e Occurs in appropriate location Refers to specific,

• bserved

behaviors Limited in amount

See Auditing Tool-Handout

Bottom Line

• 1. Identify ways to engage with your learners

(learn about your self and them)

• 2. Implement learning inventories / tools that best

suite your experiential practice

• 3. Explore different feedback

processes – one size may not fit all

• 4. Model reflective learning as part of your

feedback strategies