Transcript Effective Feedback

Effective Feedback
Fiona Spencer
What is feedback?
‘information given to a trainee with the
intention to improve their performance’
When do we give feedback?
When do we give feedback?
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When a trainee undertakes a WpBA?
When completing a CS report?
When completing an ES report?
When a trainee makes a mistake?
When a trainee undertakes a procedure?
When a trainee does something well?
After an examination?
When do we give feedback?
All the time!
Why do we give feedback?
Johari’s Window
Known to self
Unknown to self
Known to others OPEN
BLIND SPOT
Unknown to
others
CLOSED
FAÇADE
Why do we give feedback?
Strengths
Areas for
development
Appraisee
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Appraiser
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A Simple Model of Competence
Does
Shows how
Knows how
Knows
HIERARCHY OF KNOWLEDGE –
determining the learner’s knowledge
Open Question
How well have you managed this patient?
What have you learnt?
In this patient, what is the diagnosis?
Is there a treatment plan?...likely
outcome?
What do these findings mean?
What are the causes?...effects?
Evaluation
Analysis
Synthesis
Comprehension
What do you understand by…?
Facts
What, when, where?
Adults learn best when:
When clear objectives are set
– And they help set them
• The learning is purposeful and structured
– Relevant to their needs
• They are actively involved
• A variety of learning methods are used
• Builds on their previous experience
• When feedback is given
• They engage in reflection
Few trainees perceive they receive
regular effective feedback
Sometimes we don’t give good
feedback
Feedback boxes on WpBAs
“Read more around subject”
“Do more”
“More practice”
“Do harder cases”
“No problems”
“Competent”
So what makes it effective/good
feedback?
Effective Feedback
• In order to be effective it must be given and
received appropriately
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Given immediately if possible so fresh in mind
Builds on strengths and needs
Describes behaviour and impact
Specific and Sensitive
Involves the appraisee
Confronts important or difficult issues
Gives guidance on rectifying behaviour
Is understood and accepted by the appraisee
Is from a respected source
Why go over what went well?
• Use a positive critique
– ‘Well done – I really liked the way you did ….’
This re-enforces good practice and encourages
trainees to retain and build on the good aspects
and not misinterpret this area
– Increases trainee motivation and completes the
learning cycle of reflection, action planning and
future repeat (improved) performance
Giving feedback when not so good!
• Trainees try to jump to this often but do
positives first
• Retain the positive theme by feeding back
what they can do to improve, rather than
what they are not good at
– ‘In order to make that even more effective….’
• Focus on 1 or 2 important areas for
development at a time
Feedback – Pendleton’s rules
• Clarify any points of information/fact;
• Ask the learner what s/he did well – ensure that they identify
the strengths of the performance and do not stray into
weaknesses;
• Discuss what went well, adding your own observations, reenforce positives, keep to the strengths.
• Ask the learner to say what went less well and what they
would do differently next time.
• Discuss what went less well, re-enforce what you agree with
adding your own observations and recommendations of
something you would like them to do differently
• Agree an action plan- get commitment from trainee and
make sure they understood the points made
Effective Feedback
• In order to be effective it must be given and
received appropriately
– Given immediately if possible so fresh in mind
– Builds on strengths and needs
– Describes behaviour and impact
– Specific and Sensitive
– Involves the appraisee
– Confronts important or difficult issues
– Is understood and accepted by the appraisee
Is this a bit artificial?
• It can be with senior trainees so can use
alternative approach
• Start with “Can I make a suggestion….”
• Give 2 reasons why you think it is a good idea:
one suggesting what it would achieve and
something it would prevent or solve
• Make an overall positive statement about the
learner or their abilities
– “With your expertise at X this would be likely to give
an excellent outcome…”
Feedback sandwich
• If you want to make a development point eg
about a step in procedure or in a busy clinic
• Say something positive
• Make development point
• Say something positive
• How many positive points do we need to hear to
cope with a negative one?
Informal vs Formal Feedback
• Day to day in context of work activities
• Frequent
• Discuss skills or specific behaviours in small
doses
• Consider separate planned formal feedback
sessions
• Prepare by collecting info from other sources
too
Practice giving feedback
• Notes re scenarios and role play
• In 3s
– Trainee
– Trainer
– Peer observer
Examples of good feedback?
Make WpBAs more valuable
• Make sure you record the feedback given
• Timely fashion
• Make sure trainee reflection is included
– Pendleton’s rules
• Be focussed, specific objectives
– SMART
• Ask trainee to repeat the task working on those
areas to show development
– Agreed action plan
What else to give feedback on?
• Think about other useful areas
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Communication skills/attitudes to staff or patients
Consent
Documentation
Running a list of procedures
Coping with case load
Time management
Supervising a junior trainee
Quality improvement ideas/projects
Organising teaching
Chairing a meeting
Summary
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When to give feedback – All the time
Why we give feedback – Encourages learning
How not to give feedback
What is effective feedback
Ways to give feedback -Pendleton’s rules
Practiced feedback