GIVING EFFECTIVE FEEDBACK:
A TEACHER’S TOOLKIT
INTAPT
APRIL 8, 2011
FACILITATORS
•
•
•
•
•
Glenda Bendiak
Annie Cloutier
Kathleen Doukas
Paula Shing
Donna Spaner
2
FORMING, STORMING, NORMING,
PERFORMING!
3
HOW DID I GET HERE?
How did YOU come to be here, on
this day, in this workshop, as this
person?
4
RESULTS OF NEEDS ASSESSMENT
• Short needs assessment conducted October 24,
2010 after workshop outline presentation
• Purpose: guide our group in developing a workshop
that met needs of other learners
• 7 people completed needs assessment
• Response rate = 70%
5
RESULTS OF NEEDS ASSESSMENT
• Question 1. How important is feedback in teaching
situations?
• All respondents indicated feedback was either important
or very important
• Question 2. How comfortable are you giving
feedback to learners?
• All respondents were either very uncomfortable or
somewhat uncomfortable giving feedback
6
RESULTS OF NEEDS ASSESSMENT
• Question 3 – “What would you like to learn about
giving feedback?”
 How to give negative feedback/difficult learners(3)
 Strategies for providing constructive feedback(1)
 How to give meaningful, concise and useful
feedback(3)
7
RESULTS OF NEEDS ASSESSMENT
• Question 4 -“What are the biggest barriers you face
in giving feedback?”
 The problem learner/resistant learner(4)
 Lack of time(2)
 Concern about upsetting the learner(1)
8
LEARNING OBJECTIVES
• To describe qualities of effective feedback
• To appreciate common barriers to giving feedback
and giving feedback in difficult situations
• To incorporate a feedback model in the form of a
toolkit framework with concise and meaningful take
home messages
• To develop an increased comfort level with giving
feedback
• To demonstrate increased ability to integrate newly
used feedback skills through role play
9
THE TOOLKIT
10
What is Feedback?
11
FEEDBACK: THE NEED FOR A
DEFINITION
• Although feedback is viewed as important, there is little
consensus on its definition
• The agreement on the meaning of feedback between
the instructor and student is not always evident
• Instructors frequently believe they are giving feedback,
whereas trainees report feedback is rare
• Research on effective feedback cannot be performed
without a clear operational definition of feedback
Van de Ridder JMM, Stokking KM, McGaghie WC, ten Cate OTJ. What is
feedback in clinical education? Med.Educ. 2008 February;42(2):189-197
12
PROPOSED DEFINITION
• Feedback is:
• “Specific information about the comparison
between a trainee’s observed performance and
a standard, given with the intent to improve the
trainee’s performance.”
Van de Ridder et al
13
Why do you think feedback is important?
14
FEEDBACK – WHY IS IT IMPORTANT?
• Studies confirm that the human learning process at
all levels can be substantially enhanced with
knowledge of progress and specific directions for
improvement
• Without such feedback, learning is slow, difficult and
sometimes virtually impossible
Astin,1993
15
FEEDBACK: WHY IS IT IMPORTANT?
• Helps learner achieve their learning goals
• enforces engagement with learner’s training
• Without feedback, mistakes can go uncorrected
and bad habits can develop
• the learner may also drop positive behaviours or make
inaccurate assumptions
Piccinin, Crisiti & McCoy, 1999
16
FEEDBACK: WHY IS IT IMPORTANT?
• Needed for the development of competency and
expertise
• Clinical reasoning
• Critical thinking
• Judgment
• Facilitates learning process and teaching performance
• Improves teaching skills
• University teachers receiving feedback aimed at improving
teaching showed improvement immediately post consultation
and this continued to be observable 3 y later
Piccinin, Crisiti & McCoy, 1999
Côté et Bélanger, 2006
17
THE EVIDENCE FOR FEEDBACK
• 1912 – Thorndike’s study
• providing simple feedback about line length allowed
students to draw lines of specified length faster vs. those
who received no feedback
• OSCE (1992)
• Students who performed OSCE with 2min of feedback
significantly improved performance on identical stations vs.
controls
• Improvement is maintained up to 3 mo later
Shannon & Norman, 1995
18
THE EVIDENCE FOR FEEDBACK
• Feedback in medical interviewing skills (1986)
• Improved interviewing performance immediately and 5y later vs
controls
• Feedback delivered in the sandwich manner (positivenegative-positive) is rated most desirable, acceptable and
accurate by students
• Feedback from a group leader or preceptor is valued more
than feedback from peers or patients
• Feedback including objective evidence of performance may
be more effective than specific comments from an observer
Shannon & Norman, 1995
19
Setting the Tone
20
HOW TO PREPARE TO GIVE FEEDBACK:
SETTING THE TONE
• Create a positive relationship, a climate of trust and
safety (non-threatening)
• Choose appropriate physical location/ environment
as able
• Collect descriptive data while observing actual
performance (write it down!)
• You should target specific performance and changeable
behaviours
21
QUESTIONS TO ASK YOURSELF…
• What was performed well and what could be performed differently?
• What specific behaviours do I want to comment on?
• Can this behaviour be modified and if so, what behaviour would I like to
see in its place?
• What is the priority for improvement?
• How can I express respect and support for the learner as I provide
feedback?
• Is it the right time and place?
Dent & Harden, 2009
Mckinley, Williams & Stephenson, 2010
22
• “Students will forget what you said and they will forget
what you did BUT they will never forget how you made
them feel”.
Piccinin, 2003
23
WATCH, CONSIDER, DISCUSS!
What do you think of the feedback
given in the following video clips?
24
25
Principles & Qualities of Effective Feedback
26
PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
• Feedback is effective if it:
•
•
•
•
promotes learning
increases motivation
enhances self esteem
leads to deepening of relationship between the
giver and receiver
Piccinin, 2003
27
PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
• Solicited
• a person requesting feedback is more likely to accept
feedback and respond to it
• Attentive, caring and respectful in delivery
• more fruitful to emphasize positive consequence of their
amended performance than to use threats
• Collaborative
• reduces power distance in the relationship, more
egalitarian, less threatening, more encouraging
Côté et Bélanger, 2006
28
PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
• Well-timed
• as soon as possible after the event keeping it concrete and
relatively free of distortion from lapse of time
• Expected
• Clear and Direct / Specific
• focus specifically on behaviour, not general performance
• give feedback on decisions and actions, not on an
interpretation of the student’s motive or personality traits
• Rounded or balanced
• giving positive and negative
• Use descriptive terms
• Provides direction for improvement
Côté et Bélanger, 2006
29
PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
• When feedback is subjective, label it as such
• Using“I” statements expresses feedback in terms of personal
opinions, feelings and your assessment of the situation
• Using evaluative statements beginning with“you” tends to
sound accusatory
• Make Eye contact
• Control emotions, try to keep cool
• Try not to overload the learner, be selective and limit to 1
or 2 items only
• Too much constructive or negative feedback can demoralize
the learner
Côté et Bélanger, 2006
30
PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
• Encourage reflection; ask for self-assessment
• this can create insight into their behaviour, move the discussion
to a more complex level and form a basis for improvement
• Label clearly as feedback
• Check for understanding
• Ask for a summary of what the student has retained
• Propose pedagogic follow-up
Côté et Bélanger, 2006
31
SUMMARY: EFFECTIVE FEEDBACK
Relevant
Factual and Descriptive
Timely, Frequent and Expected
Specific and Focused on behaviour/performance
• Target an alterable behaviour; must be able to “prove”
• Helpful with direction for improvement
• Balanced
• Collaborative
•
•
•
•
Dent & Harden, 2009
32
Types of Feedback
33
TYPES OF FEEDBACK
• Verbal
• Non-verbal
• we continuously send and receive non verbal messages
• via tone of voice, raised eyebrow, smile, frown, hand
gesture or body movement simultaneously
34
TYPES OF FEEDBACK
• Formative Feedback
• Interactive activity between teacher and learner
• Purpose is to improve or modify the learner’s knowledge, skills
or attitudes
• useful in promoting learning
• should be provided on a frequent basis to a learner for most
effect
Bienstock, Katz, Cox et. al., 2007
35
TYPES OF FEEDBACK
• Summative Feedback
• Judgment is made about the learner’s performance for the
purpose of assigning grades, assessing competence, or
comparing performance to standards
• Thought of as a type of final assessment
• Not as likely to change learner’s behavior
Bienstock, Katz, Cox et. al., 2007
36
TYPES OF FEEDBACK
• Brief Feedback
• given often and is short, focused on a skill
• Formal Feedback
• provided when one sets aside time for feedback for 5-20
minutes- may be feedback about a case presentation
• Major Feedback
• scheduled feedback lasting 15-30 minutes often to address
major issues or midpoint review
Branch & Paranjape, 2002
37
Models of Feedback
38
THE SANDWICH TECHNIQUE
• Reinforcing Statement: positive remark or
observation to learner
• Constructive Comment: constructive
observations ,
examples that need
change
• Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant , 2008
39
THE SANDWICH TECHNIQUE
Google images
40
A REAL-LIFE EXAMPLE
• Mr. X is a 73 year old man with metastatic lung cancer. He is
on a Palliative Care Unit and his condition is deteriorating. A
family meeting is held to clarify advance directives, as well as
discuss the extent of illness and prognosis with patient and his
family.
• The Learner chairs the family conference while the teacher
observes.
• The Learner and teacher meet after the conference to discuss
how things went.
41
Role Play!
42
THE SANDWICH TECHNIQUE
• Reinforcing Statement: positive remark or
observation to learner
• Constructive Comment: constructive
observations ,
examples that need
change
• Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant, 2008
43
SANDWICH MODEL - STRENGTHS
• Good way of giving specific feedback to support
learning in a way that promotes respect,
understanding and corrective action
• Can be done quickly
44
SANDWICH MODEL - CHALLENGES
• Praise may obscure the corrective comment or
serve no function
• Learner may get tuned in to the “praise -criticismpraise pattern” and come to be expecting criticism
• Subsequently, student learns to discount the praise
• Mostly a one-way transmission of information from
the teacher to the learner
45
THE PENDLETON MODEL
• Structured approach for talking about a learner’s
performance after an educational encounter
• such as a case presentation, consultation or a practical skill
• Pendleton’s rules build on the Feedback Sandwich
to promote a two- way process
• allows the learner to make observations about his or her
own performance.
Cantillon & Sargeant, 2008
46
PENDLETON’S RULES
• Briefly clarify matters of fact
• Learner states what was good about his/her performance
• Teacher states areas of agreement and elaborates on good
performance
• Learner then states what was poor or could have been
improved
• Teacher then states what he or she thinks could have been
improved
Cantillon &Sargeant, 2008
47
A REAL-LIFE EXAMPLE
• Mr. X is a 73 year old man with metastatic lung
cancer. He is on a Palliative Care Unit and his
condition is deteriorating. A family meeting is held
to clarify advance directives, as well as discuss the
extent of illness and prognosis with patient and his
family.
• The Learner chairs the family conference while the
teacher observes.
• The Learner and teacher meet after the
conference to discuss how things went.
48
Role Play!
49
PENDLETON’S RULES
• Briefly clarify matters of fact
• Learner states what was good about his/her performance
• Teacher states areas of agreement and elaborates on good
performance
• Learner then states what was poor or could have been
improved
• Teacher then states what he or she thinks could have been
improved
Cantillon &Sargeant, 2008
50
PENDLETON’S RULES - STRENGTHS
• Like the Sandwich model, a good way to give
specific feedback in a supportive manner
• Easy to use
• Integrates the learner’s own self assessment and
allows for two way dialogue
Kurtz, Silverman & Draper, 1998
51
PENDLETON’S RULES - CHALLENGES
• Rules impose a strict order of feedback with good points
having be made before difficulties are discussed and the
learner having to make comments before the teacher
• Evaluative phrasing of feedback
• Learner’s agenda may not be discovered till late in the
feedback process when he/she will have an opportunity to
mention areas of concern
• May be an inefficient use of time
Kurtz, Silverman & Draper, 1998
52
REFLECTIVE FEEDBACK
CONVERSATION
• A modified interactive feedback approach which builds
on the Pendleton model
• Emphasizes learner’s ability to recognize his or her own
performance deficits
• includes a discussion about how the learner plans to improve
• Encourages development of reflective practice
Cantillon & Sargeant, 2008
53
REFLECTIVE FEEDBACK
CONVERSATION
• Teacher asks learner to share any concerns about a recently
completed performance
• Learner describes what they would have liked to have done
better
• Teacher provides views on performance and offers support
• Teacher asks learner to reflect on what might improve
situation
• Student responds
• Teacher elaborates on response, correcting if necessary
• Feedback ends with a clear and agreed plan for change
Cantillon & Sargeant, 2008
54
A REAL-LIFE EXAMPLE
• Mr. X is a 73 year old man with metastatic lung
cancer. He is on a Palliative Care Unit and his
condition is deteriorating. A family meeting is held
to clarify advance directives, as well as discuss the
extent of illness and prognosis with patient and his
family.
• The Learner chairs the family conference while the
teacher observes.
• The Learner and teacher meet after the
conference to discuss how things went.
55
Role Play!
56
REFLECTIVE FEEDBACK
CONVERSATION
• Teacher asks learner to share any concerns about a recently
completed performance
• Learner describes what they would have liked to have done
better
• Teacher provides views on performance and offers support
• Teacher asks learner to reflect on what might improve
situation
• Student responds
• Teacher elaborates on response, correcting if necessary
• Feedback ends with a clear and agreed plan for change
Cantillon & Sargeant, 2008
57
REFLECTIVE FEEDBACK
CONVERSATION - STRENGTHS
• Collaborative approach: interactive and engages the learner
• Encourages self-reflection with emphasis on learner’s ability to
recognize performance deficits
• Discussion flow is natural with the goal of assisting the learner in
achieving their own critical analysis
• Motivates subsequent improvement in performance
• With practice, this model can be routinely incorporated into
clinical teaching and learning
Cantillon & Sargeant, 2008
58
REFLECTIVE CONVERSATION MODEL CHALLENGES
• May be time consuming, especially initially
• May be more effective immediately after the event
which is not always possible
• May be difficult for students with poor insight
Sargeant, 2008
Cantillon &
59
SIX STEP FEEDBACK MODEL
• Based on elements necessary to improve clinical
performance:
• An observed event (learner behavior)
• An appraisal of that event( teacher’s assessment)
• A recommendation for improvement
Brown, Hodges & Wakefield, 1995
SIX STEP FEEDBACK MODEL
• The impact of Feedback is increased when
the learner compares his/her self assessment
with feedback provided about his or her
performance
Brown, Hodges & Wakefield, 1995
SIX STEP FEEDBACK MODEL
• Observe student behaviour/work
• Invite the learner’s self assessment of a clinical
encounter
• Describe the desired behaviour
• Focus on 2-3 points
• Balance between positive and negative
• Relate back to original objective
Brown, Hodges & Wakefield, 1995
Hodges, 2003
SIX STEP FEEDBACK MODEL
• Make sure the student understands the difference
between current behaviour & desired behaviour
• Ask learner to paraphrase
• Elaborate a plan to close the gap
• Elicit ideas from learner to increase motivation
• Share information rather than giving advice
• Follow-up on improvement
• Ensure that recommendations for improvement are carried out
• Assess that performance has improved and give feedback
Brown, Hodges & Wakefield, 1995
Hodges, 2003
A REAL-LIFE EXAMPLE
• Mr. X is a 73 year old man with metastatic lung
cancer. He is on a Palliative Care Unit and his
condition is deteriorating. A family meeting is held
to clarify advance directives, as well as discuss the
extent of illness and prognosis with patient and his
family.
• The Learner chairs the family conference while the
teacher observes.
• The Learner and teacher meet after the
conference to discuss how things went.
64
Role Play!
65
SIX STEP FEEDBACK MODEL
• Observe student behaviour/work
• Invite the learner’s self assessment of a clinical
encounter
• Describe the desired behaviour
• Make sure the student understands the difference
between current behaviour & desired behaviour
• Elaborate a plan to close the gap
• Follow-up on improvement
Brown, Hodges & Wakefield, 1995
Hodges, 2003
66
SIX STEP FEEDBACK MODEL- STRENGTHS
• Encourages self-assessment, a necessary skill for life
long learning
• Encourages delivery of feedback in a positive and
respectful manner
• Provides direction for improvement
• Provides follow-up to ensure that performance has
improved
SIX STEP FEEDBACK MODELCHALLENGES
• May be too time consuming to use completely in
some clinical environments
OTHER FEEDBACK MODELS
•
•
•
•
•
•
The SCOPME model*
The Chicago model*
The ALOBA model*
SET- GO method of descriptive feedback
IMPROVE Model
One-minute clinical preceptor
*Mohanna, Wall & Chambers, 2004
69
QUESTIONS?
70
HOW ARE THINGS GOING SO FAR?
71
ENJOY YOUR BREAK!
72
Tips for Giving Feedback:
The “Problem” Learner
73
PREVENTION: STEP 1!
• Easier to prevent a problem than manage it – set ground
rules!
• Primary prevention
• Know learning expectations; orient learner; learning contract;
reassess halfway
• Secondary prevention
• Watch for warning signs; give specific feedback as early as possible
(don’t “watch & wait”), reassess
• Tertiary prevention
• Seek help early; don’t be a “martyr”; don’t give an undeserved
passing grade
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
74
WHAT IS A “PROBLEM LEARNER”?
• Negative connotation
• But, present in literature
• Defined as:
• “learners who perform significantly below their potential
due to specific difficulties”
Lucas & Stallworth, 2003
75
WHY DON’T WE HELP THE LEARNER IN
DIFFICULTY MORE OFTEN?
• Numerous Barriers to feedback…
•
•
•
•
•
•
Lack skills
Fear of exposing own inadequacies
Fear of upsetting trainee
Fear of doing “more harm than good”
Fear reprisals through legal action
Lack of time
McKimm & Swanwick, 2010
Lake & Ryan, 2005
76
SOAP APPROACH
• Subjective
• What made you consider there may be a problem with the
student’s performance?
• What do others think?
• Pattern of behaviour?
• What does the learner think – “how are things going with the
rotation”?
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
77
SOAP APPROACH
• Objective
• Need to document specific examples of the problem
behaviour/interactions
• Write these down – student needs to know what exactly to
improve on
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
78
SOAP APPROACH
• Assessment
• Analyze subjective and objective components and
formulate hypotheses for why the student is in difficulty
• Several “differential diagnoses” to consider
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
79
Cognitive
Affective
Valuative
Environmental
Medical
Poor
knowledge
base
Anxiety
Expects
certain
grade/hours
/workload
Hospital vs.
Clinic-oriented
Psychiatric
illness
Time pressures
Recent illness
Learning
disability
Fear
Does not
value
rotation
Patient
population
Pre-existing
illness in poor
control (DM)
Depression
Anger
Communication
barrier
Lack of
effort/interest
Conflicting
values with
patients/staff
Substance
abuse
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
SUPERVISOR & SYSTEM FACTORS
• Previous examples were “personal factors”
• There are also supervisor or system factors:
•
•
•
•
•
Receiving no feedback/support
Being given responsibilities beyond level of competence
Interpersonal problems
Overwork
Exposure to patients with serious illness/death
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
81
SOAP APPROACH
• Plan
•
•
•
•
Gather more data (if current situation is mild)
Discuss problem with learner
Contact school/training program
Detailed, specific feedback – then, set plan for tackling the
issues and a time to re-evaluate performance
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
82
TIPS MODEL
• Categorizes problem learners as having affective, cognitive,
structural and/or interpersonal difficulties
Lucas & Stallworth, 2003
83
TIPS MODEL
• T: type and specify the ineffective behaviours
• Redirect these
• Provide detailed description about ineffective behaviours
• I: identify the category of difficulty experienced by
the learner
Lucas & Stallworth, 2003
84
TIPS MODEL
• P: perception vs. reality
• Describe the perception you have of the learner’s
behaviour, but acknowledge the learner may have a
different view
• S: strategy for treatment/follow-up
• Discuss concerns with director/experts, as well as the learner
• Include consequences if student does not follow steps for
improvement
Lucas & Stallworth, 2003
85
GIVING THE FEEDBACK
• The critical intervention of having a private
discussion with the trainee requires:
• Setting aside time in a confidential setting;
• Getting student to speak first (positive critique);
Lake & Ryan, 2005
86
GIVING THE FEEDBACK
• Defining the issues involved (important, measurable,
reproducible?);
• Determining the remediable cause(s);
• Agreeing on an action plan; and
• Monitoring outcomes and following up
• with frequent feedback
Lake & Ryan, 2005
Gordon, 2003
87
CALL FOR HELP!
**Remember! If you have
major concerns about a
learner, you have an
obligation as a teacher
and professional to discuss
these with both the learner
and the appropriate
program contact(dean,
program director, etc.)
88
How to Role Play:
Ground Rules
89
GOALS OF ROLE PLAY
• Opportunity to practice giving feedback
• Obtain feedback on your feedback
• Identify difficulties encountered while
giving feedback
• Determine strategies to overcome these
90
GROUPS OF THREE
• Student
• Trainee in an ambulatory clinic
• Receiving end-of-rotation feedback
• Preceptor
• Supervising preceptor in an ambulatory clinic
• Observer
• Extra eyes and ears, keeper of field notes
91
FORMAT
• 10 minutes: Review and prepare for role
• 20 minutes: Give feedback!!
• 15 minutes: Discuss within large group
– What worked well?
– What could be improved and how?
92
GROUND RULES
• Time-outs are encouraged!
– Rewind/fast-forward to repeat scenarios
– Rerun scenario with different feedback method
• Sharing /trading roles is encouraged!
– Rerun scenario with different roles
• Respect for each other is essential!
– Privacy must be respected
93
Feedback Away!
94
DEBRIEFING
• Preceptors …
– What was most difficult to discuss with the student?
– What was the easiest?
• Students …
– How did you feel when receiving feedback?
– What was your reaction?
• Observers …
– What went well?
– What problems did you notice?
95
Receiving Feedback
96
RECEIVING FEEDBACK
• Receiving feedback involves thinking of it as new
information, focusing on trying to understand it and
clarifying the meaning of the feedback.
Piccinin, 2003
97
FACTORS THAT AFFECT HOW
FEEDBACK IS RECEIVED
• Receiver’s Self Confidence
• the greater the receiver’s level of self confidence, the easier it
is for that person to respond to feedback
• Type of Feedback being Given
• major difficulty is receiving negative feedback
• Relationship between Giver and Receiver
• feedback from a trusted source is better received
Piccinin, 2003
98
STRATEGIES FOR RECEIVING FEEDBACK
EFFECTIVELY
• Preparatory Phase
• Keep in mind that feedback is valuable to all of us
• Receiving Phase
• Listen carefully to the entire feedback
• Try not to be defensive or to argue
• Paraphrase the content of the feedback
• Recognize the validity of the feedback
• Provide information to correct misinformation
• Say what you intend to do about the feedback received
Piccinin, 2003
99
STRATEGIES FOR RECEIVING FEEDBACK
EFFECTIVELY
• Follow up Phase
• collaboratively set definite dates or times to monitor progress
toward implementation of the action steps decided on.
Piccinin, 2003
100
RECEIVING FEEDBACK: SUMMARY
Listen to the feedback
Ask for it to be repeated if you did not hear
Assume it is constructive till proven otherwise
Pause and think before responding
Ask for clarification or examples if statements are
unclear or unsupported
• Accept feedback positively
• Ask for suggestions of ways that you might modify
behavior
• Respect and thank the person giving the feedback
•
•
•
•
•
http://londondeanery.ac.uk, 2010
101
THE FEEDBACK TOOLKIT
102
QUESTIONS TO ASK YOURSELF…
• What was performed well and what could be performed differently?
• What specific behaviours do I want to comment on?
• Can this behaviour be modified and if so, what behaviour would I like to
see in its place?
• What is the priority for improvement?
• How can I express respect and support for the learner as I provide
feedback?
• Is it the right time and place?
Dent & Harden, 2009
Mckinley, Williams & Stephenson, 2010
103
SUMMARY: EFFECTIVE FEEDBACK
Relevant
Factual and Descriptive
Timely, Frequent and Expected
Specific and Focused on behaviour/performance
• Target an alterable behaviour; must be able to “prove”
• Helpful with direction for improvement
• Balanced
• Collaborative
•
•
•
•
Dent & Harden, 2009
104
THE SANDWICH TECHNIQUE
• Reinforcing Statement: positive remark or
observation to learner
• Constructive Comment: constructive
observations ,
examples that need
change
• Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant, 2008
105
PENDLETON’S RULES
• Briefly clarify matters of fact
• Learner states what was good about his/her performance
• Teacher states areas of agreement and elaborates on good
performance
• Learner then states what was poor or could have been
improved
• Teacher then states what he or she thinks could have been
improved
Cantillon & Sargeant, 2008
106
REFLECTIVE FEEDBACK
CONVERSATION
• Teacher asks learner to share any concerns about a recently
completed performance
• Learner describes what they would have liked to have done
better
• Teacher provides views on performance and offers support
• Teacher asks learner to reflect on what might improve
situation
• Student responds
• Teacher elaborates on response, correcting if necessary
• Feedback ends with a clear and agreed plan for change
Cantillon & Sargeant, 2008
107
SIX STEP FEEDBACK MODEL
• Observe student behaviour/work
• Invite the learner’s self assessment of a clinical
encounter
• Describe the desired behaviour
• Make sure the student understands the difference
between current behaviour & desired behaviour
• Elaborate a plan to close the gap
• Follow-up on improvement
Brown, Hodges & Wakefield, 1995
Hodges, 2003
108
TIPS MODEL
• T: type and specify the ineffective behaviours
• Redirect these
• Provide detailed description about ineffective behaviours
• I: identify the category of difficulty experienced by
the learner
• affective, cognitive, structural and/or interpersonal
Lucas & Stallworth, 2003
109
TIPS MODEL
• P: perception vs. reality
• Describe the perception you have of the learner’s
behaviour, but acknowledge the learner may have a
different view
• S: strategy for treatment/follow-up
• Discuss concerns with director/experts, as well as the learner
• Include consequences if student does not follow steps for
improvement
Lucas & Stallworth, 2003
110
RECEIVING FEEDBACK: SUMMARY
Listen to the feedback
Ask for it to be repeated if you did not hear
Assume it is constructive till proven otherwise
Pause and think before responding
Ask for clarification or examples if statements are
unclear or unsupported
• Accept feedback positively
• Ask for suggestions of ways that you might modify
behavior
• Respect and thank the person giving the feedback
•
•
•
•
•
http://londondeanery.ac.uk, 2010
111
Now, we would appreciate
your feedback!
112
LEARNING OBJECTIVES
• To describe qualities of effective feedback
• To appreciate common barriers to giving feedback
and giving feedback in difficult situations
• To incorporate a feedback model in the form of a
toolkit framework with concise and meaningful take
home messages
• To develop an increased comfort level with giving
feedback
• To demonstrate increased ability to integrate newly
used feedback skills through role play
113
FEEDBACK WORKSHOP
• How did we feel the workshop went?
• Overall impressions
•
•
•
•
•
Material covered and well researched?
Clarity, organization?
Time allotment for each section?
Role play/interactive component?
Audiovisual aids and materials?
114
HOW DID THINGS GO (IN GENERAL?)
115
FEEDBACK WORKSHOP
• What did you feel went well?
• What could we change/improve on for next time?
• What (if anything) was missing?
• What one pearl will you take back to your
clinic/hospital/teaching from this workshop?
116
THANK YOU
• Thank you for attending our workshop!
• Thank you also to the INTAPT instructors for your help
and guidance
• Thank you to Rob Blain
• Toolkit creator!
117