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On Delivering (And Receiving) Feedback

John T. Benjamin MD The Teaching Center UNC Department of Pediatrics

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Teaching Thoughts

• “Teaching is not a lost art, but the regard for it is a lost tradition.” Jacques Barzun • “Teachers need to be and teach learners how to be stewards for self directedness.” John Parboosingh MD

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Why Give Feedback?

• An essential part of training and of measuring teaching effectiveness.

• Should encourage self-reflection, raise self awareness; help students plan for future learning and practice keeping self-image intact.

• Can help prevent distress (burnout)

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Feedback vs. Evaluation

• These two terms are not equivalent.

• Evaluation is what is done at the end of the experience with the learner. Feedback should be happening as go along.

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2 Types of Feedback

• Formal: scheduled; this is incorporated into the evaluations of learners.

• Informal: daily as relates to specific events: presentations, write-ups, behavior, etc.

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How often should formal feedback occur?

• Learners state that doesn’t happen often • Teachers state it occurs more often than learners think. Recommendation: Always label: “now you are getting feedback”

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Barriers to Giving Feedback

• • Our own feelings of inadequacy Arranging time to do it • Others?

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Receiving vs. Giving Feedback

• Do you recognize yourself, your teachers in any of these descriptions?

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Receiving Feedback: Learner is:

• • • Negative/Closed » Disrespectful, closed, inactive listening, rationalizing, patronizing, superficial, denies, defensive, attacking Positive/Open » Open, responsive, accepting, respectful, engaged, active listening, thoughtful, interested, sincere.

Think about feedback you have received and give examples of how you responded in each of these ways

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Giving Feedback: Teacher is:

• • Ineffective/Negative Delivery » Vague, insensitive, disrespectful, judgmental, general, poor timing, impulsive, selfish Effective/Positive Delivery » Supportive, direct, sensitive, considerate, descriptive, specific, good timing, helpful • Give examples of both that you have experienced

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How Do We Give Effective Feedback?

• • • • Day 1 Expectations of when meet Do it at the right time and right way Be supportive and specific Summarize at end and state when will occur again

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Day 1 Clarify Expectations

• • • “Friday will be feedback day” Then on Friday, make sure you give each person feedback or reschedule if you have to. You have made a commitment to do this.

On day 1, explain why feedback is so important to have done – this motivates learners to do their best.

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Feedback: Formal 5-10 minutes a Week

• • • • Organized in advance and predictable – not just when things go wrong. Private setting.

Start by saying: This is our feedback session. Then ask: “How do you think things are going?” and then listen carefully.

If no response then: “What things are going well for you? Not so well?”

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Criteria for Giving Feedback

• • • • • Given with Care Given with Attentive Listening Invited by Learner Specific Fully Expressed • • • • • Objective Well-timed Directed toward changeable behavior Checked and clarified Evaluated

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Do not give feedback when:

• Learner is post-call • You are tired and/or angry at the learner • Other responsibilities conflict with the interaction

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Do not be vague: eg don’t say:

• • • Good Job (doesn’t mean much) You are doing great (ditto) You did …….; you said…….; you were disorganized……you were better at the beginning of the presentation……;

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Be as specific as you can: do say:

• Overall, I think things are going well, but: » I observed that…..

» » » Could you clarify…. It seems to me…..

In your presentation, it would have been helpful if you had…..

• When would you like to meet next for a followup to this meeting?

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Giving Positive Feedback

• • • • Needs to be specific Shows spontaneity, variety – not the same as you gave the student before this one.

Rewards specific effort that you noticed Provides information about competence, value of accomplishments, progress

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Unanticipated Consequences of Giving Positive Feedback

• • • Often confirms learner’s opinion of themselves.

You are considered omniscient You get a good evaluation from the learner. One faculty member said: “I am very popular with students – I give them all honors.”

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Giving “Constructive” Feedback

• If learner comes up with areas to work on: » Develop a plan of action which includes rechecking with learner in a few days » » » Must also include areas that are going well and emphasizing the importance of them.

Ask: “What are you going to change?” At follow-up session, praise specific improvement: “this is much better, because..”

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Unanticipated Consequences of “Constructive” Feedback

• • • • • If negative enough, learner will “ding” teacher on teacher evaluation.

Learner may not say “thank you” Learner may not really learn much or change their ways, but some will.

Makes you feel bad – this is not why we went into teaching What if learner doesn’t get it?

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Conclude Feedback

• Summarize and give a plan of action if needed.

• If problem, identify specific time to meet again in 3-4 days.

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Our Job

• Give feedback that is constructive; learners will consider it either positive or negative, but our goal is to help the learner improve and grow.

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Video of Giving Feedback

• • • • Show video Discuss: what did senior person do well? What did senior person not do well?

What did learner do well?

What did learner not do well?

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Exercise - Groups of 3: 1 learner, 1 teacher, 1 observer

• Example 1. Student seems uninterested, gives poor eye contact and messes with palm pilot constantly.

• Example 2: Student shows up late and leaves early. He seems unhappy; has gotten only A’s so far.

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Exercise #2 – score sheet

• Score Sheet: Observer to give feedback to the teacher; learner can add opinion as well.

• If time for a second case, rotate roles.

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Evaluation: Base on levels of Learning RIME:(Lewis First)

• Observer only (F) • Reporter only (+/- P) • Interpreter (HP) • Manager (H) • Educator: Resident Level

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Evaluation: Grade as a Group

• Issues with Honors/High Pass/Pass • Combine forces with other attendings to come to group consensus! (example of how not to do it: Teach Attending/generalist).

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Evaluation: despite our best efforts

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Summary and Conclusions

• • • • Feedback should be given on each rotation Day 1 – set expectations Always be constructive and positive Recognize: Not everyone will be ready to hear what you have to say.