Transcript Feedback & Evaluation: Getting the “Grade” Right

Feedback & Evaluation:
Quick Tips for Clinical
Preceptors (Part 1)
Shirley Schlessinger, MD, FACP
Associate Dean for Graduate Medical Education
University of Mississippi Medical Center
“You can observe a lot
just by watchin’.”
Yogi Berra
But things will never CHANGE if you don’t
comment on what you see!
Why ? (You know it’s important!)
 Performance
does not reliably
improve without evaluation and
feedback
 Key responsibility of the clinicianteacher faculty member
 ALL of us can get better at what we
do…
Why not? (Our lowest scores as faculty!)
I
didn’t have “enough exposure”
to the trainee
 I don’t know what to say
 Am I being fair?
 I don’t want to hurt their feelings
 I don’t want to hurt their career
 I don’t want to be sued
So…Let’s get better!!!
 Clearly
establish expectations for
learners
 Understand the tools you need for
evaluation (assess /measure!)
 Have faith in your learners’ desire to
improve!
 Develop skills in targeted observation
and constructive feedback
Feedback “Shapes” Behavior
 Timely
 Objective
 Focused
 Useful
•What did the learner do well?
•Where do they need to improve?
•What are next steps they can take?
Prepare Resident for Feedback
 Why
feedback will be given?
– “Be all that you can be…”
 When
will feedback be given?
– Micro-feedback
– Macro-feedback
– Formative & Summative evaluations
 How
will feedback be given?
Provide this info at the BEGINNING of
the rotation; STICK to the PLAN!
Micro –vs- Macro Feedback
MICRO
 Instantaneous
 Pure coaching
 Flexible format
 May be given in
group setting
 May occur in
response to a
single observation
MACRO
 Cumulative over time
 May be formative or
summative
 Coaching & Judging
 Structured format
(competency based)
 Should be a private
session
Micro & Macro Feedback
 More
effective when initiated with
self-evaluation
 Should be clearly linked to
expectations / goals and objectives
 Should be linked to next steps
 Macro-feedback should build on and
reinforce microfeedback!
Microfeedback Template
Look for behaviors to reinforce as well as
correct
 Provide immediate feedback when possible
 Be brief and focus on a single issue
 Be specific about what you saw
 Avoid speculating on intentions
 Use nonjudgmental language
 Encourage self-evaluation and reflection
 Identify “next-time” behaviors

Preparing to Give MacroFeedback
Read your residents’ notes
 Consciously observe your residents
interacting with families, nurses,
pharmacists, social workers
 Watch your resident examine patients
 Probe your resident for evidence-based
decision making
 Consider patterns of behavior
 Consider how your resident has responded
to “micro-feedback”
 Identify a private place to provide
feedback

Macrofeedback Template
Ask: “What do you see as your strengths?
What do you see as your weaknesses”
 Tell: Summarize your observations and
ideas; include both positive and negative
feedback in each competency domain if
possible (even the best resident can get
better!!!)
 Ask: “What are your next steps?”; guide
resident in developing goals for growth

Hints for “Tell”
 Focus
on observations: “You did such
and such…” versus “You are…”
 Focus on descriptions, not judgments:
“What I observed was…” versus
“Your examination was inadequate
because…”
 Focus on specific details, not
generalities: “At the start of the
interview with Mrs. Jones, I noticed…”
versus “Your introductions are all…”
DO…











Define expectations early
Get DATA (Observe, Observe, Observe)
LABEL it FEEDBACK!
Target to trainee level
Consider timing
Give feedback regularly
Ask for “self-evaluation” by trainee
Be positive when deserved
Be specific as possible
Focus on the clinically significant
Encourage trainee responsibility
DON’t…










Don’t be angry when giving feedback
Don’t give feedback in public or emotionally
charged settings
Don’t try to cover too much
Don’t lecture
Don’t be completely negative (NEVER be
demeaning…)
Don’t provide compliments only
Don’t criticize the personality (behavior!!)
Don’t ignore problems!!
Don’t wait until the end to give negative
feedback
Don’t put negative comments on paper, until
discussed in person
“Without feedback, mistakes go
uncorrected, good performance
is not reinforced, and clinical
competence is achieved
empirically or not at all…”
Jack Ende, 1983
Do not ignore problems!
They will NOT go away…
And finally…
Fill out the WRITTEN evaluations requested
by the education office in a TIMELY fashion!!
– This is a measure of YOUR
professionalism!
 Provide written comments
– Source of motivation for high performers
– Road-map for improvement for others
– Remembered by learner LONG after
numbers are forgotten!!!
– Promote personal growth
