09-11-06 The Importance of Feedback Donna M. Costa Feedback has been identified as one of the most critical components of clinical supervision.1 As supervisors, we provide feedback to our students throughout the fieldwork assignment, and they provide feedback to us at the end of the fieldwork. However, because of the many meanings attributed to feedback, there are often anxieties on the part of both the fieldwork educator and the student about giving and receiving feedback. Students will often ask for "constructive criticism," yet some supervisors dread having to sit down with them to provide feedback on their performance. Many students say that they did not receive sufficient feedback throughout their fieldwork experience, and yet their supervisors believed that they were providing feedback to their students all of the time. It is worth exploring what is meant by feedback, and under what conditions the use of feedback is most helpful. Feedback is broadly defined as any information that one person gives to another about that person. In the context of fieldwork education, feedback is "information given to indicate the level of performance that has been achieved in performance of a task. Feedback can therefore be positive or negative depending on whether the task was completed well or not" (p. 63).2 The clinical supervision literature defines feedback more broadly as "information that supervisors communicate to their supervisees about aspects of their skills, attitudes, behavior, and appearance that may influence their performance with clients or affect the supervisory relationship" (p. 3).3 Feedback in fieldwork education can either be formal (such as using the Fieldwork Performance Evaluation4 or Student Evaluation of Fieldwork Experience5) or informal (such as a meeting that occurs between the supervisor and student after a client evaluation). There have been relatively few studies on feedback in the supervision literature, and none that I could find in the occupational therapy literature. One case study that is often cited in the supervision literature was done by Friedlander, Siegel, and Brenock6 and described how few of a supervisor's comments include feedback. Another study reported that 98% of supervisors of graduate student counselors admitted to withholding feedback.7 Their reasons for doing so included anticipating a negative reaction from the supervisee, and feeling that the feedback was too personal. What makes feedback effective for fieldwork students? The following strategies will help ensure that feedback enhances their learning and is perceived as being helpful, rather than punitive. • Establish a climate of trust so feedback is not viewed as criticism. • Make it clear to students at the beginning of the fieldwork experience that you will be giving them regular feedback, and tell them • • • • • • • • • • • • • • • • how you will be giving it (e.g., via weekly summaries, after each client evaluation, etc.). Provide feedback in a private setting rather than in front of others. Create an environment that invites self-assessment (e.g., start by asking, "So, how would you describe this treatment session?"). Keep feedback timely; provide it as soon as possible after the situation. Link the feedback to what each student wants to learn (e.g., "You said at the beginning of fieldwork that you wanted to increase your assertiveness skills, so let's talk about how you set limits with this morning's client."). Provide feedback only if you actually observed the student. Relaying secondhand or thirdhand information comes across as weak. It also opens you up to being challenged, and increases the chance that the feedback will be discounted. Use nonjudgmental language when giving students feedback; focus on objective behavioral terms. Give students specific examples of instances of their behavior, rather than using generalizations. Frame the feedback as information about the students' performance or behavior, rather than as statements about their personality or judgments about them as people. Don't overload students with too much feedback; it is better received in small "chunks" that they can reflect on and discuss later. Be prepared for variation in responses; not all students will react in the same way to similar feedback. Use supportive techniques when providing students with feedback to demonstrate that you are invested in helping them learn. When you have to give a student negative feedback about performance, help turn it into a goal or challenge that he or she wants to work on. Encourage your students to ask for feedback and point out to them the many other venues for getting feedback (e.g., fellow students, other professionals on the team, clients). Provide students with learning activities that promote reflective practice and lead to self-assessment. Follow up with a student after providing corrective feedback to see how he or she has responded. Use "sandwiched" feedback for students who are very sensitive to negative feedback—comment first on something the student did well, followed by the corrective feedback, then end with another positive comment about their performance. Many fieldwork supervisors are reluctant to give feedback because they don't want to seem critical or unsupportive of students. However, students need feedback to acquire the skills necessary to become solid practitioners. If you follow the guidelines above, most students will be grateful for the feedback, and you will have made a valuable contribution to the profession. References 1. Bernard, J., & Goodyear, R. (2004). Fundamentals of clinical supervision. Boston: Allyn & Bacon. 2. Rose, M., & Best, D. (Eds.). (2005). Transforming practice through clinical education: Professional supervision and mentoring. New York: Churchill Livingstone. 3. Hoffman, M., Hill, C., Holmes, S., & Freitas, G. (2005). Supervisor perspective on the process and outcome of giving easy, difficult, or no feedback to supervisees. Journal of Counseling Psychology, 52(1), 3–13. 4. American Occupational Therapy Association. (2002). Fieldwork performance evaluation for the occupational therapy or occupational therapy assistant student. Bethesda, MD: Author. 5. American Occupational Therapy Association. (2000). Student evaluation of fieldwork experience. Retrieved July 7, 2006, from http://www. aota.org/nonmembers/area13/docs/studeval.doc 6. Freidlander, M., Siegel, S., & Brenock, K. (1989). Parallel processes in counseling and supervision: A case study. Journal of Counseling Psychology, 36, 149–157. 7. Ladany, N., & Melincoff, D. (1999). The nature of counselor supervisor non-disclosure. Counselor Education and Supervision, 38, 161– 176. Donna M. Costa, MS, OTR/L, is the interim program director at Stony Brook University in Stony Brook, New York, and the academic fieldwork coordinator representative on AOTA's Commission on Education. Reference Information: Costa, D. M. (2006). The importance of feedback. [Electronic Version]. OT Practice, 11(16), 7–8. ©Copyright 2007. The American Occupational Therapy Association. All rights reserved.