Feedback & Evaluation:
Quick Tips for Clinical
Preceptors (Part 2)
Shirley Schlessinger, MD, FACP
Associate Dean for Graduate Medical Education
University of Mississippi Medical Center
Importance of Feedback
“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!”
Jack Ende, MD
JAMA, 1983
Formative –vs- Summative
Evaluation
 Formative
evaluation is “coaching”
and guiding
 Formative evaluation INCLUDES
informal, regular (daily) feedback
 Mid-month formative evaluation can
assure RECOGNITION of feedback by
learner
 Summative evaluation is “judging” or
grading…
Errors in Evaluation
Leniency Error- tendency to give all
students “good” scores
 Severity Error- tendency to give all
students “low” scores
 Range Restriction- scoring all
competency domains the same
 “Halo” / “Horn” Error-ratings based
on reputation of trainee
 First Impression Error- failure to give
feedback and opportunity to improve
 Friendship bias

Learners in Difficulty
True knowledge, skills, attitudes
deficiencies ???
 Environmental confounding factors?
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
New baby
Divorce
Depression
Physical / Mental illness
Drugs or alcohol
Learning Disability
Always Notify the Program Director!!!!
Learner Dissatisfaction /
Disagreement with Feedback
Not all learners will react well to
constructive criticism (negative feedback!)
 Similar to “Breaking Bad News” to patients
 Acknowledge learner’s emotion
(disappointment, frustration, anger,
denial, etc…)
 Focus on behavior (limited number of
issues!)
 Outline opportunities for improvement
 Emphasize professional responsibility to
be the best physician they can be!

The INSIGHT Model
Inquiry
 Needs
 Specific Feedback
 Interchange
 Goals
 Help
 Timing of Followup session

Compare to:
Ask… (self-eval)
Tell…
Ask… (action plan)
Inquiry
 How
does the learner think things
are going?
 Listen to the learner’s need in detail
– Listening attentively and thoroughly
before commenting may be all you need
to do, especially for minor / temporary
problems…
Needs
 What
does the learner feel he/she
needs during this rotation?
 Ask the learner to define personal
educational goals
 Learners accept feedback better
when they feel the teacher has first
understood their perspective…
Specific Feedback
 Give
your constructive feedback as
specifically as you can
 Start with positive feedback
 The more concrete and behavior
focused the feedback, the better it
will go
 Limit to just two or three key issues
 Verify the learner’s understanding of
the feedback you’ve given
Interchange
 Give
the learner time to respond to
your feedback
 Discuss learner’s role in the team
 Ask the learner to brain-storm with
you ways the team can work better
 Work together to identify innovative
ways to enhance the learning
experience
Goals
 Review
existing goals for the rotation
 Ask the learner to state new goals,
 Reinforce any new goals you’ve just
reached together
 Verify that you both understand and
agree on these goals
Help
 Does
the learner have any serious
problems that merit a “learning
consultation”?
– Chief Resident
– Attending Physician
– Program Director / Service Chief
– Learning Specialist
– Student / Employee Health
– Human Resources
– Other????
Timing of Follow-up session
 Any
final questions or comment???
 When would you and the learner like
to meet again to go over how things
are going?
Be Prepared
 You
will be a better “coach” if you
have prepared adequately to give
your learners feedback
– OBSERVE them!!!
– Critically consider their performance
– Identify ways they can provide better
patient care
– Think “Life long learning” skills
And Finally…
 Don’t
forget you have learners at
many different levels on your clinical
teams
 ALL need feedback / evaluation
 Be familiar with the institutional
expectations of each level of learner
 Tailor feedback to their levels as
learners, and their specific needs!