Giving Educational Feedback
An Interactive Skills Development
Workshop with Feedback as the
Content Element
Felise B. Milan, MD
Michael J. Reichgott, MD, PhD
Goals of this workshop are to:
 Train faculty in educational methods for
developing a workshop on giving feedback
to medical students.
 Demonstrate a model of interactive small
group skills teaching.
 Demonstrate use of supportive educational
materials for a feedback workshop.
 Present content elements pertaining to the
use of formative feedback in medical
education.
Learning Objectives
Participants will:
 Know the elements of giving feedback.
 Demonstrate the skills of giving formative
feedback using interactive methods.
 Initiate a plan to develop a workshop at
his/her site using the educational materials
provided.
Basic feedback
 “Feedback refers to information describing
a student’s performance in a given activity
that is intended to guide their future
performance in that same or in a related
activity. It is a key step in the acquisition of
clinical skills.*”
* Ende, J. MD, Feedback in Clinical Medical Education, JAMA 1983; 250:777-781
Feedback as “Coaching”
 Basic feedback is analogous to coaching in
any setting. Performance is observed and
the elements are evaluated. The ‘coach’
gives feedback (instruction) to the student
with respect to elements of behavior or
performance that require improvement.
Principles of Basic Feedback
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Feedback should be delivered in private.
Feedback should be planned in advance.
Feedback should be performance specific.
Feedback should not pertain to personal characteristics.
Feedback should be descriptive, not judgmental.
Feedback should be given timely to the observation it
addresses.
Feedback should be focused on specific observations.
Feedback should be based on first-hand observation and/or
written evaluations.
Feedback should balance positive and negative comments.
Feedback should benefit the receiver, not soothe the giver.
The ‘Feedback Sandwich
 The ‘Feedback Sandwich’ maintains
a trust environment:
 State (based on observation):
 What was done well…
 What could be changed or improved…
 How improvement might be achieved…
The Expanded ‘Feedback Sandwich
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“What do you think you did well?”
“What do you think needs improvement?”
 (the student is usually on target)
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“This is what I saw that went well.”
“This is what I saw that needs improvement.”
 (generally there is concurrence)
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“How would you try to improve?”
“Here are some suggestions you might try.”
“Which of these would you like to try first?”
Advanced Feedback
 Required when responding to a
substantially negative aspect of
student behavior or performance.
 Can not be entirely objective way.
 Higher level of tension than basic feedback
 Strong possibility that the student will
demonstrate defensive reaction.
PEARLS
Partnership for joint problem-solving
Empathic understanding
Acknowledgement
Respect for values and choices
Legitimation of feelings and
intentions
 Support for efforts at correction
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Transtheoretical Model
Precontemplation
“Relapse”
Contemplation
Maintenance
Preparation
Action
Stages of “Readiness to Change”
 Identify understanding
 Provide information
 Provide support
Precontemplation
Not aware
Contemplation
Aware but  Identify goals
ambivalent Define discrepancy between goals and
performance/behavior
 Emphasize self-motivation
Preparation
Committe
d to
change
 Support commitment
 Plan strategies
Action
Has
initiated
change
 Identify resources
 Identify barriers
 Anticipate relapse
Maintenance
Change is
stable
 Support behaviors
 Foster development of new goals
“Relapse”
Undesired
behaviors
recur
 Identify “relapse”
 Review motivation
 Review resources
 Develop new strategies