Transcript Review of feedback for trainers

Review of feedback for trainers
DR ALEXANDRA BATES
BUCKS VTS
Why do we do it?
 Providing information about performance/behaviour
with the aim of affirming or developing
performance/behaviour.
 Summative: at end of course and includes a
summary of achievements. Given to affect quantity
of performance.
 Formative: Given to affect quality of performance.
Aims to improve performance and how they can
improve. Should enable learners to self reflect.
Johari’s window
Positivity of feedback
 Most people want to know how they are doing.
 People want to know if others like what they are
doing
 They also want to know if something could be done
more effectively.
Feedback is….
 Not about blame, approval or disapproval.
 Neutral- it describes what happened compared to a
standard or intent
 Not about telling someone what to do
 Not about making judgements
Poor feedback
 Negative emphasis: feedback should also reveal areas
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of strength
Flavour of the month approach: meaninglessly
compared to others
Poor communication about the purpose:
No action or support
Lack of confidentiality
How may learners and trainers react to feedback?
Trainee
 Denial
 Rationalise
 Anger
 Blame
Trainer
Colluding
Obligation
Moral high ground
Burying/fudging
Minimising
Jennifer King, BMJ 1999
Prepare to give feedback
 Ask yourself:
What is my intention behind giving this feedback?
How am I feeling bout giving this feedback?
How is the other person feeling?
How to give effective feedback
 Information: hard facts, concrete data and clear
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examples not assumptions
About performance/behaviour: not about who they
are/personality
Affirm or develop behaviour: be clear on intended
outcome before giving the feedback
Timing: is it a good time to receive feedback? Is it soon
after the event?
Environment
Use microskills: active listening, cues,open questions,
challenge, summarise, facilitate reflection
Brown and Leigh 1996 Constructive feedback(
based on behaviour not personality)
Descriptive: I notice that….
Specific: when you did/said this I noticed the
patient….
Timely: given as close to the event as possible
Selective: 1-2 issues at a time
Suggestions: do you it might be helpful if…
Pendleton’s rules 1984
 Trainee asked to identify their own strengths
 Trainer reinforces these with other strengths
 Trainee asked to identify areas for improvement
 Trainer reinforces these adding others if needed
SET-GO descriptive outcome based feedback
Silverman et al 1997
What I saw…: descriptive, specific and non
judgemental
What else did I see… what happened next
What did you/others think? Allows reflection
Clarify goal to be achieved: use an outcome based
approach
Offers/suggestions of how to get there:
suggestions/alternatives
Useful for feeding back in small groups
ALOBA agenda led outcome based analysis
 Start with leaners agenda
 Look at the outcomes learner and patients are trying
to achieve
 Encourage self assessment and problem solving first
 Involve rest of group in problem solving
Keep the feedback descriptive, balanced, well
intentioned and supportive, offer alternatives.
Gibbs reflective cycle 1988
Description
What happened?
Action Plan
If it arose again, what
would you do?
Feelings
What were you thinking
and feeling?
Evaluation
What was good and bad
about the experience?
Conclusion
What else could you
have done?
Analysis
What sense can you
make of the situation?
How to handle bad reactions to feedback
 Name and explore the resistance: you seem very upset abut this….
 Keep the focus positive: let’s go over your strengths
 Try to convince the trainee to own one part of the problem: so
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would you agree that on this occasion you did lose your temper…?
Negotiate: I can help you with this but I need you to …
Allow time out: do you need some time to think about this…?
Explore the resistance to understanding the feedback: help me
understand why you feel so angry…
Keep the responsibility where it belongs: what will you do to
address this?
If in denial: reiterate the facts, what you saw and heard
If trying to justify or defensive: refer to standards expected and ask
what could be done differently next time.