FeedbackFeedback

Dr.Reem Al Afari, MD.MedMedical Education

Department

Dr.Reem Al Afari, MD.MedMedical Education

Department

ObjectivesObjectives

1. Explain the difference between Evaluation and Feedback

2. State the 6 Stages of Feedback

3. State the Benefits of Giving Feedback

4. Learn at least one new way to facilitate effective feedback.

1. Explain the difference between Evaluation and Feedback

2. State the 6 Stages of Feedback

3. State the Benefits of Giving Feedback

4. Learn at least one new way to facilitate effective feedback.

QuestionnaireQuestionnaire

Please fill in the Pre-Workshop Questionnaire for discussion later.

Please fill in the Pre-Workshop Questionnaire for discussion later.

Evaluation vs. FeedbackEvaluation vs. FeedbackEvaluation:

– A systematic procedure for assessing a sample of a student’s behaviour in order to measure that behaviour against standards and norms

Feedback:– The process by which the teacher

provides learners with information about their performance for the purpose of improving their performance.

Evaluation:– A systematic procedure for assessing a

sample of a student’s behaviour in order to measure that behaviour against standards and norms

Feedback:– The process by which the teacher

provides learners with information about their performance for the purpose of improving their performance.

Video Clip for Discussion…Video Clip for Discussion…

Pre-Workshop Questionnaire Discussion…Pre-Workshop Questionnaire Discussion…

Nutrition BreakNutrition Break

Why is effective feedback important?

Why is effective feedback important?

Why is effective feedback important?Why is effective feedback important?

• For you as a Teacher• For the Student• For Humanity

• For you as a Teacher• For the Student• For Humanity

For youFor you

1. It is fun to teach and share ideas

2. It can build rapport between you

and the student

1. It is fun to teach and share ideas

2. It can build rapport between you

and the student

For the StudentFor the Student

3. Improves performance

4. Giving feedback helps students establish and meet their own goals

5. Giving feedback helps teach critical appraisal of own work

3. Improves performance

4. Giving feedback helps students establish and meet their own goals

5. Giving feedback helps teach critical appraisal of own work

For the StudentFor the Student

6. Giving feedback is a platform to introduce new ideas and resources7. Without feedback, bad habits form8. Without feedback, positive behaviors may diminish due to lack of

reinforcement

6. Giving feedback is a platform to introduce new ideas and resources7. Without feedback, bad habits form8. Without feedback, positive behaviors may diminish due to lack of

reinforcement

For the StudentFor the Student

9. Generates confidence10. Effective feedback promotes feelings of competence11. Giving feedback shows students you care about them and their learning12. It teaches them how to be good teachers

9. Generates confidence10. Effective feedback promotes feelings of competence11. Giving feedback shows students you care about them and their learning12. It teaches them how to be good teachers

For HumanityFor Humanity

13. It is our responsibility to educate the next generation of HCPs14. Feedback can inspire the next generation of HCPs

13. It is our responsibility to educate the next generation of HCPs14. Feedback can inspire the next generation of HCPs

When to Give FeedbackWhen to Give Feedback

When to give feedbackWhen to give feedback

1. After and NOT before observation2. Appropriate place/setting3. Appropriate time4. After you have invited the student’s

self-critique

1. After and NOT before observation2. Appropriate place/setting3. Appropriate time4. After you have invited the student’s

self-critique

1. Give Feedback after and NOT Before Observation

1. Give Feedback after and NOT Before Observation

• Only give feedback on what you have observed.

• Only give feedback on what you have observed.

2. Choose an appropriate place/setting2. Choose an appropriate place/setting

• Quiet environment; no interruptions• Arrange seats in a neutral configuration

CHOOSE THE RIGHT SETTING:• Small group:

– if it will not make the student feel uneasy• Privately:

– For individual feedback– Topics of a sensitive nature

• In front of patient:– Only if not embarassing

• Quiet environment; no interruptions• Arrange seats in a neutral configuration

CHOOSE THE RIGHT SETTING:• Small group:

– if it will not make the student feel uneasy• Privately:

– For individual feedback– Topics of a sensitive nature

• In front of patient:– Only if not embarassing

3. Choose an appropriate time3. Choose an appropriate time• Give feedback routinely• Plan a time• Ask permission: “Is this a good time?”• As close to event as possible• AFTER objectives given to student• Ideally, AFTER student feels comfortable

with you• AVOID premature feedback

• Give feedback routinely• Plan a time• Ask permission: “Is this a good time?”• As close to event as possible• AFTER objectives given to student• Ideally, AFTER student feels comfortable

with you• AVOID premature feedback

4. Give Feedback after you have invited the student’s self-critique

4. Give Feedback after you have invited the student’s self-critique

• How would you ask a student for his/her self assessment?

• How would you ask a student for his/her self assessment?

Who should give feedback?Who should give feedback?

Who should give feedback?Who should give feedback?

• An observer who is:– Knowledgeable about the situation– Experienced in the clinical setting

• In certain circumstances, patients can be an important source of feedback.

• An observer who is:– Knowledgeable about the situation– Experienced in the clinical setting

• In certain circumstances, patients can be an important source of feedback.

How to make feedback more effective…

How to make feedback more effective

How to make feedback more effective

The aim of giving feedback to trainees is to help them reach their potential at their particular stage of training.

The aim of giving feedback to trainees is to help them reach their potential at their particular stage of training.

To make feedback effective:To make feedback effective:

1. Know when.2. From the person who observes

the trainee.3. Non-evaluative language.4. Be specific, not generalized.5. Focus on actions rather than

personality.

1. Know when.2. From the person who observes

the trainee.3. Non-evaluative language.4. Be specific, not generalized.5. Focus on actions rather than

personality.

6. Describe or model the desired behavior

7. Ensure that the students understand the difference between the current and desired behavior

8. Develop a plan to close the gap: Educational Rx.

9. Follow-up on improvement

6. Describe or model the desired behavior

7. Ensure that the students understand the difference between the current and desired behavior

8. Develop a plan to close the gap: Educational Rx.

9. Follow-up on improvement

To make feedback effective:To make feedback effective:

Potential barriers to effective feedback:Potential barriers to effective feedback:

• Fear of upsetting the trainee.• Fear of doing more harm than good.• Poor handling of the trainee’s reaction.• Lack of guidance.• Multiple resources with inadequate and

inconsistent feedback.• Lack of respect for the source who gives

feedback.

• Fear of upsetting the trainee.• Fear of doing more harm than good.• Poor handling of the trainee’s reaction.• Lack of guidance.• Multiple resources with inadequate and

inconsistent feedback.• Lack of respect for the source who gives

feedback.

Paired ExercisePaired Exercise

• Pair up with your neighbour• 1 person = artist; 1 person = coach• Goal: To replicate a picture as accurately as

possible to the original

• Pair up with your neighbour• 1 person = artist; 1 person = coach• Goal: To replicate a picture as accurately as

possible to the original

Note: Each pair will have a different picture

Paired ExercisePaired Exercise

COACH• Coach the artist to

draw the picture

COACH• Coach the artist to

draw the picture

ARTIST:• You will NOT be able

to look at the picture• You will draw the

picture purely through your coach’s instruction and feedback

ARTIST:• You will NOT be able

to look at the picture• You will draw the

picture purely through your coach’s instruction and feedback

Rules contd.Rules contd.

COACHES:• Verbal Instructions

Only• Hands holding folder

or on your lap:– No hand gestures – No pointing

• Use your feedback skills

COACHES:• Verbal Instructions

Only• Hands holding folder

or on your lap:– No hand gestures – No pointing

• Use your feedback skills

ARTISTS:• Use the pencils and

erasers provided• You are allowed to

point or gesture• No peeking!

ARTISTS:• Use the pencils and

erasers provided• You are allowed to

point or gesture• No peeking!

You have 10 minutes to complete the drawing

Nutrition BreakNutrition Break

Helping learners give feedback to each other…Helping learners give feedback to each other…

I’m the medical student. I don’t know what you have but Dr. Smith says it’s bad.

Helping Learners give Feedback to Each Other

Helping Learners give Feedback to Each Other

What are the benefits? - it prepares the student for

future responsibilities- peers may have good insight

into challenges- you learn when you teach- can encourage collegiality and

strengthen team approach

What are the benefits? - it prepares the student for

future responsibilities- peers may have good insight

into challenges- you learn when you teach- can encourage collegiality and

strengthen team approach

• Provide learners with the rationale for small group critique

• Ask learners to generate guidelines surrounding feedback

• Provide learners with the rationale for small group critique

• Ask learners to generate guidelines surrounding feedback

Helping Learners give Feedback to Each Other

Helping Learners give Feedback to Each Other

Guidelines for small group critiqueGuidelines for small group critique

• self-critique first• give feedback directly, do not talk about

a group member who is not present• say it how you would like it said to you• use examples to illustrate point • link negative observation to

concrete recommendations

• self-critique first• give feedback directly, do not talk about

a group member who is not present• say it how you would like it said to you• use examples to illustrate point • link negative observation to

concrete recommendations

• Be prepared to intervene if necessary

• Giver learners an opportunity to respond to critiques

• Give feedback on how they are giving feedback to each other

• Be prepared to intervene if necessary

• Giver learners an opportunity to respond to critiques

• Give feedback on how they are giving feedback to each other

Helping Learners give Feedback to Each Other

Helping Learners give Feedback to Each Other

Helping Patients give Feedback to Learners

Helping Patients give Feedback to Learners

Explain to the patient prior to learner-patient encounter:

• Why feedback is important• Expectations of patient• Discuss patient concerns

– Reassurance of no negative consequences– Evaluation is of the learner, not the patient

Explain to the patient prior to learner-patient encounter:

• Why feedback is important• Expectations of patient• Discuss patient concerns

– Reassurance of no negative consequences– Evaluation is of the learner, not the patient

Helping Patients give Feedback to Learners Helping Patients give Feedback to Learners

Helping Patients give Feedback to Learners

Helping Patients give Feedback to Learners

• Ask patient for feedback after an encounter:– Informal enquiry– Questionnaire

• Videotape the patient-learner encounter– Ensure informed consent from pt– Review with pt and learner

• Ask patient for feedback after an encounter:– Informal enquiry– Questionnaire

• Videotape the patient-learner encounter– Ensure informed consent from pt– Review with pt and learner

Tips for Feedback Session:• Review purpose• Review everyone’s role• Assure critique is constructive

Tips for Feedback Session:• Review purpose• Review everyone’s role• Assure critique is constructive

Helping Patients give Feedback to Learners

Helping Patients give Feedback to Learners

Encourage the learner to be active in eliciting feedback from the patient:

Encourage the learner to be active in eliciting feedback from the patient:

• “How did you feel when I questioned you about your eating habits?”

• “Was I doing anything that made it hard for you to tell me your story?”

• “Was there anything that I did that allowed you to be more open?”

• “How did you feel when I questioned you about your eating habits?”

• “Was I doing anything that made it hard for you to tell me your story?”

• “Was there anything that I did that allowed you to be more open?”

Let’s summarize…Let’s summarize…

The 6 Stages of FeedbackThe 6 Stages of Feedback

1. Observe student behavior2. Ask the learner for their self-assessment3. Describe or model the desired behavior 4. Ensure that the students understand the

difference between the current and desired behavior

5. Develop a plan to close the gap: Educational Rx.

6. Follow-up on improvement.

1. Observe student behavior2. Ask the learner for their self-assessment3. Describe or model the desired behavior 4. Ensure that the students understand the

difference between the current and desired behavior

5. Develop a plan to close the gap: Educational Rx.

6. Follow-up on improvement.

Have we met the objectives?Have we met the objectives?

• What is the difference between Evaluation and Feedback?

• What are the 6 Stages of Feedback?• What are some benefits of giving

feedback (Hint: you, student, humanity)• Did you learn any new ways to facilitate

effective feedback?

• What is the difference between Evaluation and Feedback?

• What are the 6 Stages of Feedback?• What are some benefits of giving

feedback (Hint: you, student, humanity)• Did you learn any new ways to facilitate

effective feedback?

ReferencesReferences

1. Stanford University, editor. Stanford Clinical Teaching Course. Proceedings of the Stanford Clinical Teaching Course, Stanford, California. Stanford University, 2006.

2. Ende J. Feedback in Clinical Medical Education. JAMA. 1983; 250(6):777-781.

3. Hodges B. Personal communication, 2007. The Six Stages of Feedback – The Educational Prescription Workshop.

4. Westberg J, Jason J. Fostering Reflection and Providing Feedback. Helping Others Learn from Experience. Springer Series on Medical Education. New York, NY.: Springer Publishing Company, Inc, 2001.

5. Westberg, J and Jason, J (1991) Providing Constructive Feedback. A Centre for Instructional Support (CIS) Guidebook for Health Professions Teachers. Centre for Instructional Support. Boulder, CO.

1. Stanford University, editor. Stanford Clinical Teaching Course. Proceedings of the Stanford Clinical Teaching Course, Stanford, California. Stanford University, 2006.

2. Ende J. Feedback in Clinical Medical Education. JAMA. 1983; 250(6):777-781.

3. Hodges B. Personal communication, 2007. The Six Stages of Feedback – The Educational Prescription Workshop.

4. Westberg J, Jason J. Fostering Reflection and Providing Feedback. Helping Others Learn from Experience. Springer Series on Medical Education. New York, NY.: Springer Publishing Company, Inc, 2001.

5. Westberg, J and Jason, J (1991) Providing Constructive Feedback. A Centre for Instructional Support (CIS) Guidebook for Health Professions Teachers. Centre for Instructional Support. Boulder, CO.

Thank you!

Now we need your feedback…

Thank you!

Now we need your feedback…

• Post-Workshop Questionnaire

• Workshop Evaluation

• Post-Workshop Questionnaire

• Workshop Evaluation

Please fill in the following:Please fill in the following:

Types of FeedbackTypes of Feedback

Formal feedback:• Observations over a period of time .

Informal feedback:• On a day-to-day basis• Feedback is frequent• Feedback occurs in specific situations• Behaviors and skills discussed in small

doses.

Formal feedback:• Observations over a period of time .

Informal feedback:• On a day-to-day basis• Feedback is frequent• Feedback occurs in specific situations• Behaviors and skills discussed in small

doses.

Tips when giving informal feedbackTips when giving informal feedback

• Focus on actions and be specific.• Start open questions.• Avoid facial or body language.• No negative comments in front of peers.• Limit feedback to the amount of information

that trainee can use.• Engage trainee to get feedback from others.

• Focus on actions and be specific.• Start open questions.• Avoid facial or body language.• No negative comments in front of peers.• Limit feedback to the amount of information

that trainee can use.• Engage trainee to get feedback from others.