Giving feedback
Eric Bater
Trainers’ group
7th December 2010
Personal aims for workshop
Principles of feedback
• Relating to purpose of feedback
• Relating to substance of feedback
• Relating to the practicalities of feedback
Section 1
Purpose of feedback
Blindfold exercise
The blindfold game
•If we don’t give feedback what is
the learner gaining (or assuming)?
•Failing to give feedback sends
false messages, and can lead to a
lack of trust in the teacher.
‘Oh wad some Pow’r
the giftie gie us
To see oursels as
others see us!
It wad fre mony a
blunder free us
And foolish notion
Robert Burns 1786
The Johari Window
So, what is feedback?
Feedback is structured information that one
person offers to another, about the impact
of their actions or behaviour
Why give feedback?
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Influence someone to change
Recognise and reward
Improve quality of work
Build and maintain relationships
Clarify expectations
Influence motivation
Manage performance
Why give feedback?
• Helps learners to maximise their potential
at different stages of training
• Raises awareness of strengths and areas
for improvement
• Identifies actions to be taken to improve
performance
......Or as the man said
‘Without feedback, mistakes go uncorrected,
good performance is not reinforced, and
clinical competence is achieved
empirically, if at all’
Jack Ende ‘Feedback in Clinical Medical education’
JAMA 1983
Party time
Linking feedback to the learning process
The Kolb cycle 1984
Hill 2007
‘Feedback plays an important role in helping
learners move round the cycle. For example
feedback supports the process of reflection and the
consideration of new or more in-depth theory.
Through negotiation it can help the learner plan
productively for their next learning experience’
For that we need an understanding of :a) Where is the learner in terms of their learning,
level reached, past experience, goals and
understanding of learning needs’
b) Learning goals in terms of knowledge, technical
skills and attitudes
The Pygmalion effect
Might our expectations as
teachers affect the
performance of our learners?
‘The Pygmalion effect’
‘I shall always be a flower girl to Professor
Higgins because he treats me as a flower
girl..But I know I can be a lady to you
because you always treat me as a lady, and
always will’
‘Pygmalion in the classroom’
Rosenthal and Jacobson 1992’
Students whom their teachers believed to be
high performers achieved higher increase
in IQ scores after 1 year than pupils whom
teachers believed to be lower performers.
The ‘selection’ test was random.
Treat a man as he is
and he will remain as
he is.
Treat a man as he can
and should be and he
will become as he can
and should be.
Johan Wolfgang Van Goethe
Section 2
Substance of feedback
So, what are our sources of
evidence?
RCGP competence areas
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Relationships
Diagnostics
Management
Professionalism
Feedback should be......
And here’s one
I made earlier
Principles of effective feedback (1)
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Descriptive
Specific
Focussing on behaviours
It should be for the learner’s benefit
Sharing information rather than giving advice
Limited to the amount the learner can use, not
the amount you want to give
7. Solicited rather than imposed
8. Feedback only about something which can be
changed
Principles of effective feedback (II)
9. Feedback should be timely and regular
10. Focus on the positive
11.Give feedback privately (especially negative
feedback)
12.Linked to learner’s overall professional
development
13.Stay in the ‘here and now’
14.Use ‘I’ and give your experience of the
behaviour
Principles of effective feedback (III)
15. When giving negative feedback suggest
alternative behaviours
16. Give suggestions rather than prescriptions
17. Be sensitive to the impact of your message
18. Congruence between verbal and non-verbal
messages
19. Balanced
20. Encouraging reflection
21. Clear and direct
Principle 1
It should be descriptive
Giving an accurate description of
the behaviour you are talking
about
Avoiding ‘judging’ or ‘labelling’
Principle 2.
It should be specific
Be clear about what aspect of performance
or behaviour you want to talk about
Not generalised.
Principle 3.
Performance focussed
Concentration on the things that can be
changed, linking feedback to the task or
role.
Not person focused (personality, character,
attitude, or things the person cannot
change)
Principle 4
Feedback should be for the
learner’s benefit
Principle 5
Feedback should be sharing
information
Not giving of advice
Principle 6
Don’t overload
Identify two or three key messages that you
summarise at the end
Principle 7.
Feedback should be offered
Signal that you would like to give some
feedback, and why you want to give it –
wait for the person to accept the offer
Not imposed
Principle 8
Give feedback only about
something that can be changed
Principle 9
Feedback should be timely and
regular
Talk at the appropriate moment soon after
the incident. Offer feedback often.
Frequent feedback gives more practice.
Not rare, after incident is ‘stale’, not
‘batched’.
Principle 10
Focus on the positive
Principle 11
Give feedback privately
Especially more negative
feedback
Principle 12
Feedback should be given as
part of a communication
process
Used as part of a ‘developmental dialogue’
Using skills such as rapport, developing
respect, and trust with the learner
Principle 13
Stay in the ‘here and now’
Don’t bring up old concerns and previous
mistakes unless this is to highlight a
pattern of behaviours
Principle 14.
Feedback should be owned
Speak for yourself – showing the words and
feelings are your own
Not side-stepped, mixing your thoughts and
feelings with those of other people
Principle 15
Solution-focused
Show willingness to give ideas about how
the person can tackle the issues raised.
Not focusing on the problem and its potential
outcome.
Principle 16
Offer suggestions
Rather than giving ‘prescriptions’
Principle 17
Show sensitivity
Be sensitive to the impact of your
message
Feedback is for the recipient, not the
giver
Principle18
There should be congruence
between verbal and non-verbal
messages
Principle 19
Feedback should be balanced
Include a positive message to balance
points about less effective behaviour
Not one-sided
Principle 20
Encourage reflection
‘Did it go as planned?
How did you feel the patient felt?
What have you learned?
What would you differently next
time?
Principle 21
Be clear and direct
Use plain clear language
Be brief and to the point
Poor feedback leaves the recipient in doubt
about what was meant
Section 3
Practicalities of giving feedback
The old feedback sandwich
Praise
Criticism
Praise
Pendleton’s rules
• Check learner is ready for feedback
• Let learner give comments /background on
the material being assessed
• The learner states what was done well
• Observer(s) state what was done well
• Learner states what could be improved
• Observer(s) states how it could be
improved
• An action plan for improvement is made
The new feedback sandwich
Ask
Tell
Ask
Ask learner to assess their
own performance.
Phrase questions to
encourage reflection
Tell what you observed, using
specific observed behaviours
Ask about recipient’s
understanding and strategies
for improvement
What could have been done
differently?
Offer own suggestions
Commit to monitoring
improvement together
A visit to the office
Let’s give it a go
Gibbs cycle 1988
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• The SET-GO Approach to Feedback, Silverman et al (1997)
• Describe what was Seen/experience; be descriptive, specific , nonjudgemental
• Probe to discover what Else was seen/experienced; what happened
next in descriptive terms?
• Trainee describes what was Thought at the time; reflect back to
experience
• Clarify what Goal the trainee would like to achieve; use an outcome
based approach
• Explore Offers on how to achieve the goal; take suggestions and
discuss alternatives
Additional cautions for trainers:Parsloe (1995)
• Don’t take the relationship for granted,
especially if you’ve worked with learner for
some time
• Learner may be in dependant or
subordinate role
• Be clear about expectations
• Aim for supportive, relaxed, informal
environment
Common pitfalls in giving
feedback
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A negative emphasis
A ‘flavour of the month’ approach
A lack of confidentiality
Poor communication
Having no action or support
Barriers to feedback process.
1) Difficulties in giving feedback
• Believing the feedback is negative and
unhelpful
• Worrying the other person won’t like you
• Believing the other person can’t handle
feedback
• Previous experience where no change
occurred, or reaction was hostile
• Feeling feedback isn’t worth the risk
Barriers to the feedback process
2) Receiving corrective feedback
• Having the urge to rationalise, since
criticism can feel uncomfortable
• Believing self-worth is diminished by
suggestions for improvement
• Previous experience where feedback was
unhelpful or unjustified
End on Ende
‘The important things to remember about
feedback in medical education are that:1) It is necessary
2) It is valuable
3) After a bit of practice and planning it is
not as difficult as one might think’
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More Hot Tips on Feedback
Congruency, Consistency & Honesty are important
“Feedback that doesn’t talk about the other is just talking about yourself”. Often, criticism is disguised as feedback. Criticism is NOT feedback and is
often delivered more to make the giver feel better than to really help the recipient improve their performance.
The “See-Hear” Method
Tell the person what you saw or heard and the effect it had on you, rather than merely something was good or bad.
For example, “the tone of voice as you said that really made me feel you were concerned.” Is better than “that was good”
Start with the positive.
Accept and digest the feedback, especially the positive. It often helps for the receiver to hear what he/she did well first before going on to what can be
done differently. Unfortunately we live in a culture that emphasises the negative. If the positive is registered first, any subsequent negative is more
likely to be listened to and accepted.
Don’t overload the receiver. And remember, it has to be BALANCED.
You may have that urge to impart all your wisdom by giving lots of feedback, but if it all appears negative, then the receiver will just feel deflated and torn
to shreds.
So, you’ll need to prioritise your feedback in a way to ensure there is a balance between the positive and the negative.
Be clear about what the individual did well and what he or she could do to improve
Be careful of using a positive-negative-positive sandwich method of feedback such as “The first part of your presentation was well structured, but the
second part was not as clear; overall though you did really well.” This approach leaves the individual with the impression that everything is OK.
Ask questions when giving feedback
Don’t make the conversation one-sided; ask the individual what he or she thinks they did well, and where he or she thinks there’s room for improvement
and whether they agree with you. If not, explore further…. don’t just let it go!
Time your feedback
Say it while it’s fresh; don’t wait until a long time after the event (when recall difficulties set in!).
Own the feedback.
Don’t feed back on behaviour that you have not observed but that has been reported to you by someone else. Use “I” comments eg “I noticed that
xxxxx and wondered whether yyyy”
Leave the recipient with a choice
Don’t demand a change because it is more likely vs no change, but it cannot involve prescribing change.to meet with resistance.
Skilfully delivered feedback offers people information about whether to act on it or not.
It can help us to examine the consequences of change
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Common Pitfalls in Giving Feedback… things to avoid doing
A negative emphasis
It is a mistake to concentrate exclusively on a person’s weaknesses. The feedback also reveals areas of strength
about which the participant should be encouraged to feel proud and to develop further.
A "flavour of the month" approach
Where everyone is compared to each other in a displayed graphical form. Individuals may see their results as
interesting, but there is no emphasis on action for improvement. Consequently, any small benefits soon fade
away.
A lack of confidentiality
For respondents to tell the truth, they need to feel they will not be identified. If people do not trust the organisation
to respect this, they are less likely to answer truthfully.
Poor communication
If participants and respondents are not told the purpose of feedback, there will inevitably be some who invent their
own reasons. The way the feedback exercise is presented and the time invested in explaining it are crucial to the
results obtained.
Having no action or support
For feedback to be useful it must result in action. It lays the responsibility fairly and squarely on the shoulders of
the participant, but they will probably need help from a number of sources. A good facilitator can help them see the
priorities and work through an action plan.
Feedback skills
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Active listening
Observation
Clear verbal expression
Structure your message
Plan and prepare your message
Timing
Self awareness
Resilience
Assertiveness
References
Heskett EA, Laidlaw JM 2002
‘Developing the teaching instinct’
Medical Teacher 24(3) 245-8
• BMJ 7200 Volume 318: Saturday 26 June
1999 Career focus
• Giving feedback
• Providing feedback is central to training
doctors. Jennifer King considers
theoretical and practical aspects of this
important skill for all who teach or appraise
Principles of constructive feedback.
Kurtz, Silverman & Draper 1998
• Feedback should be descriptive rather than judgemental or
evaluative
• Make feedback specific rather than general
• Focus feedback on behaviour rather than personality
• Feedback should be for the learner’s benefit
• Focus feedback on sharing information rather than giving advice
• Check out interpretation of feedback
• Limit feedback to the amount of information the recipient can use
rather than he amount you’d like to give
• Feedback should be solicited rather than imposed
• Give feedback only about something that can be changed
Principles of constructive feedback
Kurtz, Silverman & Draper 1998
• Feedback should be descriptive rather than judgemental
or evaluative
• Make feedback specific rather than general
• Focus feedback on behaviour rather on personality
• Feedback should be for the learner’s benefit
• Focus feedback on sharing information rather than giving
advice
• Limit feedback to the amount of information the recipient
can use rather than the amount we would like to give
• Feedback should be solicited rather than imposed
• Give feedback only about something that can be
changed
Principles of feedback I(London
deanery)
1. Give feedback only when asked to do so or when your
offer is accepted
2. Give feedback as soon after the event as possible
3. Focus on the positive
4. Give feedback privately, especially more negative
feedback
5. It needs to be part of the overall communication
process and ‘developmental dialogue’. Use skills such
as rapport, developing respect and trust with learner
6. Stay in the ‘here and now’, don’t bring up old concerns
or previous mistakes unless these highlight a pattern of
behaviour
Principles of feedback II
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Focus on behaviours that can be changed, not personality traits
Talk about and describe specific behaviours , giving examples,
and without assuming motives
Use ‘I’ and give your experience of the behaviour (when you said,
I thought you were.)
When giving negative feedback suggest alternative behaviours
Be sensitive to the impact of your message – feedback is for the
recipient, not the giver
Consider the content of the message, the process of giving
feedback, and the congruence between verbal and non-verbal
messages
Encourage reflection (‘Did it go as planned, what would you do
differently next time,how would you feel about doing it again?.How
did you think the patient felt, what did you learn from this session))
Principles of feedback III
1. Be clear about what you are giving
feedback on,and link this to learner’s
overall professional development
2. Don’t overload- identify two or three key
messages that you summarise at the end
What constitutes effective feedback?
• Descriptive
• Performance
focussed
• Clear and direct
• Offered
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Owned
Specific
Balanced
Timely and regular
Solution-focussed
Brown and Leigh’s rules for giving
constructive feedback (from ‘The GP
Educator’s handbook)
• Descriptive
• Specific or focussed
• Directed towards behaviour that can be
changed
• Timely
• Selective
• ( Suggestions rather than prescriptions)
Criteria for effective feedback
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Descriptive - of the behaviour rather than the personality
Specific - rather than general
Sensitive - to the needs of the receiver as well as the giver
Directed - towards behaviour that can be changed ("You're too tall" is
unhelpful)
Timely - given as close to the event as possible (taking account of the
person’s readiness, etc)
Selective - addressing one or two key issues rather than too many at once
Giving informal feedback
•As soon afterwards as practical
•Positive, specific, and focussing on trainee’s strengths
•Negative feedback should be specific, nonjudgemental, and accompanied by suggestions for
alternatives.
•Encourage learners to seek feedback themselves
‘Feedback works best when sought’
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Hesketh and Laidlaw 2003
F. Hill
‘Feedback to enhance student learning:Facilitating interactive feedback on clinical
skills’
Medical Teacher 24:245-8
Nicol & Macfarlane 2006
Formative assessment and self regulation in
learners
Studies in Higher education 34(i)199-218