Feedback
Dr.Reem Al Afari, MD.Med
Medical Education
Department
Objectives
1. Explain the difference between
Evaluation and Feedback
2. State the 6 Stages of Feedback
3. State the Benefits of Giving Feedback
4. Learn at least one new way to facilitate
effective feedback.
Questionnaire
Please fill in the Pre-Workshop
Questionnaire for discussion later.
Evaluation vs. Feedback
Evaluation:
– A systematic procedure for assessing a
sample of a student’s behaviour in order
to measure that behaviour against
standards and norms
Feedback:
– The process by which the teacher
provides learners with information about
their performance for the purpose of
improving their performance.
Video Clip for Discussion…
Pre-Workshop Questionnaire
Discussion…
Nutrition Break
Why is effective feedback
important?
Why is effective feedback
important?
• For you as a Teacher
• For the Student
• For Humanity
For you
1. It is fun to teach and share ideas
2. It can build rapport between you
and the student
For the Student
3. Improves performance
4. Giving feedback helps students
establish and meet their own goals
5. Giving feedback helps teach critical
appraisal of own work
For the Student
6. Giving feedback is a platform to
introduce new ideas and resources
7. Without feedback, bad habits form
8. Without feedback, positive behaviors
may diminish due to lack of
reinforcement
For the Student
9. Generates confidence
10. Effective feedback promotes feelings of
competence
11. Giving feedback shows students you
care about them and their learning
12. It teaches them how to be good teachers
For Humanity
13. It is our responsibility to
educate the next generation
of HCPs
14. Feedback can inspire the next
generation of HCPs
When to Give Feedback
When to give feedback
1.
2.
3.
4.
After and NOT before observation
Appropriate place/setting
Appropriate time
After you have invited the student’s
self-critique
1.
Give Feedback after and NOT
Before Observation
• Only give feedback on what you
have observed.
2. Choose an appropriate
place/setting
• Quiet environment; no interruptions
• Arrange seats in a neutral configuration
CHOOSE THE RIGHT SETTING:
• Small group:
– if it will not make the student feel uneasy
• Privately:
– For individual feedback
– Topics of a sensitive nature
• In front of patient:
– Only if not embarassing
3. Choose an appropriate
time
•
•
•
•
•
•
Give feedback routinely
Plan a time
Ask permission: “Is this a good time?”
As close to event as possible
AFTER objectives given to student
Ideally, AFTER student feels
comfortable with you
• AVOID premature feedback
4. Give Feedback after you
have invited the student’s
self-critique
• How would you ask a student for
his/her self assessment?
Who should give feedback?
Who should give feedback?
• An observer who is:
– Knowledgeable about the situation
– Experienced in the clinical setting
• In certain circumstances, patients
can be an important source of
feedback.
How to make feedback more
effective…
How to make feedback
more effective
The aim of giving feedback to trainees is to help
them reach their potential at their particular
stage of training.
To make feedback effective:
1. Know when.
2. From the person who observes
the trainee.
3. Non-evaluative language.
4. Be specific, not generalized.
5. Focus on actions rather than
personality.
To make feedback
effective:
6. Describe or model the desired
behavior
7. Ensure that the students understand
the difference between the current
and desired behavior
8. Develop a plan to close the gap:
Educational Rx.
9. Follow-up on improvement
Potential barriers to effective
feedback:
•
•
•
•
•
Fear of upsetting the trainee.
Fear of doing more harm than good.
Poor handling of the trainee’s reaction.
Lack of guidance.
Multiple resources with inadequate and
inconsistent feedback.
• Lack of respect for the source who gives
feedback.
Paired Exercise
• Pair up with your neighbour
• 1 person = artist; 1 person = coach
• Goal: To replicate a picture as accurately as
possible to the original
Note: Each pair will have a different picture
Paired Exercise
COACH
ARTIST:
• Coach the artist to
draw the picture
• You will NOT be able
to look at the picture
• You will draw the
picture purely
through your coach’s
instruction and
feedback
Rules contd.
COACHES:
• Verbal Instructions
Only
• Hands holding folder
or on your lap:
– No hand gestures
– No pointing
ARTISTS:
• Use the pencils and
erasers provided
• You are allowed to
point or gesture
• No peeking!
• Use your feedback
skills
You have 10 minutes to complete the drawing
Nutrition Break
Helping learners give
feedback to each other…
I’m the medical student. I
don’t know what you have but
Dr. Smith says it’s bad.
Helping Learners give Feedback
to Each Other
What are the benefits?
- it prepares the student for
future responsibilities
- peers may have good insight
into challenges
- you learn when you teach
- can encourage collegiality and
strengthen team approach
Helping Learners give Feedback
to Each Other
• Provide learners with the rationale for small
group critique
• Ask learners to generate guidelines
surrounding feedback
Guidelines for small group
critique
• self-critique first
• give feedback directly, do not talk about
a group member who is not present
• say it how you would like it said to you
• use examples to illustrate point
• link negative observation to
concrete recommendations
Helping Learners give Feedback
to Each Other
• Be prepared to intervene if
necessary
• Giver learners an opportunity to
respond to critiques
• Give feedback on how they are
giving feedback to each other
Helping Patients give Feedback to
Learners
Helping Patients give
Feedback to Learners
Explain to the patient prior to
learner-patient encounter:
• Why feedback is important
• Expectations of patient
• Discuss patient concerns
– Reassurance of no negative consequences
– Evaluation is of the learner, not the patient
Helping Patients give Feedback to
Learners
• Ask patient for feedback after an
encounter:
– Informal enquiry
– Questionnaire
• Videotape the patient-learner encounter
– Ensure informed consent from pt
– Review with pt and learner
Helping Patients give Feedback to
Learners
Tips for Feedback Session:
• Review purpose
• Review everyone’s role
• Assure critique is constructive
Encourage the learner to be active in
eliciting feedback from the patient:
• “How did you feel when I
questioned you about your eating
habits?”
• “Was I doing anything that made it
hard for you to tell me your
story?”
• “Was there anything that I did that
allowed you to be more open?”
Let’s summarize…
The 6 Stages of Feedback
1.
2.
3.
4.
Observe student behavior
Ask the learner for their self-assessment
Describe or model the desired behavior
Ensure that the students understand the
difference between the current and
desired behavior
5. Develop a plan to close the gap:
Educational Rx.
6. Follow-up on improvement.
Have we met the objectives?
•
•
•
•
What is the difference between
Evaluation and Feedback?
What are the 6 Stages of Feedback?
What are some benefits of giving
feedback (Hint: you, student, humanity)
Did you learn any new ways to facilitate
effective feedback?
References
1. Stanford University, editor. Stanford Clinical Teaching Course.
Proceedings of the Stanford Clinical Teaching Course, Stanford,
California. Stanford University, 2006.
2. Ende J. Feedback in Clinical Medical Education. JAMA. 1983;
250(6):777-781.
3. Hodges B. Personal communication, 2007. The Six Stages of
Feedback – The Educational Prescription Workshop.
4. Westberg J, Jason J. Fostering Reflection and Providing
Feedback. Helping Others Learn from Experience. Springer
Series on Medical Education. New York, NY.: Springer
Publishing Company, Inc, 2001.
5. Westberg, J and Jason, J (1991) Providing Constructive
Feedback. A Centre for Instructional Support (CIS) Guidebook
for Health Professions Teachers. Centre for Instructional
Support. Boulder, CO.
Thank you!
Now we need your
feedback…
Please fill in the following:
• Post-Workshop Questionnaire
• Workshop Evaluation
Types of Feedback
Formal feedback:
• Observations over a period of time .
Informal feedback:
•
•
•
•
On a day-to-day basis
Feedback is frequent
Feedback occurs in specific situations
Behaviors and skills discussed in small
doses.
Tips when giving informal
feedback
•
•
•
•
•
Focus on actions and be specific.
Start open questions.
Avoid facial or body language.
No negative comments in front of peers.
Limit feedback to the amount of information
that trainee can use.
• Engage trainee to get feedback from others.