Transcript UI College of Medicine Teaching Scholars Program 1999-2001

Feedback
Jonathan Silverman
Aarhus
2012
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Feedback
1.
Identify the problems you face in providing feedback
2.
Principles of feedback
3.
Avoiding defensiveness
4.
Summary of take-home strategies
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Feedback
1.
Identify the problems you face in providing feedback
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Pairs
Somebody you don’t know so well
Talk about your experience the difficulties
of feedback
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Feedback
1.
Identify the problems you face in providing feedback
2.
Principles of feedback
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
What is feedback?
Feedback is the art of
observation
(of actions)
and description
(of outcomes)
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Purpose of feedback
• to provide information about someone’s performance
• intended to guide future performance
• designed to influence, reinforce, or change behaviour,
concepts or attitudes
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Gathering data for feedback
• Learners don’t perceive feedback as valid unless
based on data
• Observation precedes feedback
• Data should be first hand
(or if not, triangulated)
• Data about behaviours, not inferences
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
A very difficult job
for feedback first you need data
firstly identify what you want to feedback
about
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
A very difficult job
for feedback first you need data
firstly identify what you want to feedback
about
now a demonstration of how
now remodel how that was done
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Observation and Feedback
Feedback tips:
• Start with learner agenda
– Ask learner what feedback would be
helpful to them?
• What were they trying to accomplish?
• Did they feel they accomplished it?
• What skills might assist in reaching
objective?
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Observation and Feedback
Feedback tips continued:
• Be behaviorally specific
• Describe what you observed and relate
to objectives
• Balance feedback between what could
be improved and what was effective
• Starting with learner agenda means areas for
improvement may go first
• Limit amount of feedback
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Principles of GIVING constructive feedback
• Give feedback as soon after the event as possible
• Give feedback only about something that can be changed
• Make feedback specific rather than general, with concrete examples
• Use “I” and give your experience of the behaviours
• Focus your feedback on behaviour rather than personality
• Limit feedback to the amount of information that the recipient can use
rather than the amount you would like to give
• Your feedback should be for the learner’s benefit, not for yours
• Check the interpretations and consequences of your feedback
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Feedback
1.
Identify the problems you face in providing feedback
2.
Principles of feedback
3.
Avoiding defensiveness
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Defensive versus supportive climate
Description
Evaluation
Problem Orientation
Control
Spontaneity (flexibility)
Strategy (hidden agenda)
Empathy (involvement)
Neutrality (indifference)
Equality
Superiority
Provisionalism (tentativeness)
.
Certainty (dogmatism)
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
A plan
• Start with the receiver of feedback , their agenda, their selfassessment
• Give feedback that is descriptive rather than judgmental or evaluative
• Give balanced feedback – what worked and what could be done
differently
• Specific behaviour amenable to change
• Look at outcomes and alternatives
• Ends with an action plan
• Follow-up
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Principles of agenda-led outcome-based analysis
Organising the feedback process
Start with the learner’s agenda
ask what problems the learner experienced and what help he would like from
the rest of the group
Look at the outcomes learner and patient are trying to
achieve
thinking about where you are aiming and how you might get there
encourages problem solving - effectiveness in communication is always
dependent on what you and the patient are trying to achieve
Encourage self assessment and self problem solving first
allow the learner space to make suggestions before the group shares its ideas
Involve the whole group in problem solving
encourage the group to work together to generate solutions not only to help
the learner but also to help themselves in similar situations
Principles of agenda-led outcome-based analysis
Giving useful feedback to each other
Use descriptive feedback to encourage a nonjudgmental approach
descriptive feedback ensures that non-judgmental and specific
comments are made and prevents vague generalisation
Provide balanced feedback
encourage all group members to provide a balance in feedback of
what worked well and what didn’t work so well, thus supporting each
other and maximising learning - we learn as much by analysing why
something works as why it doesn’t
Make offers and suggestions; generate alternatives
make suggestions rather than prescriptive comments and reflect them
back to the learner for consideration; think in terms of alternative
approaches
Be well intentioned, valuing and supportive
it is the group’s responsibility to be respectful and sensitive to each other
Principles of agenda-led outcome-based analysis
Ensuring that analysis and feedback actually lead to deeper
understanding and development of specific skills
Rehearse suggestions
try out alternative phrasing and practice suggestions by roleplay - when learning any
skill, observation, feedback and rehearsal are required to effect change
Value the interview as a gift of raw material for the group
the interview provides the raw material around which the whole group can explore
communication problems and issues: group members can learn as much as the
learner being observed who should not be the constant centre of attention.
Opportunistically introduce theory, research evidence and wider
discussion
offer to introduce concepts, principles, research evidence and wider discussion at
opportune moments to illuminate learning for the group as a whole
Structure and summarise learning so that a constructive end point is
reached
structure and summarise the session using the Calgary-Cambridge guides to ensure
that learners piece together the individual skills that have arisen into an overall
conceptual framework
Feedback
1.
Identify the problems you face in providing feedback
2.
Principles of feedback
3.
Avoiding defensiveness
4.
Summary of take-home strategies
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine