The Effect of Positive and
Negative Verbal Feedback on
Surgical Skills Performance and
Motivation
Aarthy Kannappan, MD
Dana Yip, MD
Nayna Lodhia, BS
John Morton, MD
James Lau, MD, FACS
Stanford Department of General Surgery
Characteristics of Good Feedback
• Timely
• Specific
• Given in small quantities
• Non-evaluative
• Non-judgmental
Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81
Verbal Feedback in Surgery
• Prevalent surgical culture prone to negative and
evaluative feedback
• “Constructive criticism” thought to be the best way to
improve skills performance *
• Affects of feedback on teacher-learner relationships, and
learner motivation to study and practice not well studied
*Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A
randomized controlled trial. Med Educ. 2006 Aug;40(8):746-9.
Study Questions
• How do positive and negative verbal feedback affect
immediate skills performance?
• What is the effect of such feedback on the teacherlearner relationship?
• What is the effect of such feedback on the trainee's
motivation to learn and engage in skills practice?
Study Specifics
25 1st year medical students with little
to no laparoscopic experience
Perform FLS peg- transfer.
Positive Verbal
Feedback (n=12)
Negative Verbal
Feedback (n=13)
Repeat FLS peg-transfer task.
Survey Administered
Debrief
Skills Performance Results
Interpreting Results
• No significant difference in skills performance (time and
number of errors)
• Could be due to non-specific nature of the feedback
• Most feedback in surgery is non-specific, learners unclear
how to improve
Survey Results
Interpreting Results
• Teacher- Learner Relationship
• Positive feedback from a mentor: relationship with that individual
would improve either somewhat (28%) or greatly (68%)
• Negative Feedback from a mentor: relationship with that
individual would deteriorate either somewhat (28%) or greatly
(72%).
• Individuals learn best from physicians they wish to emulate*
*Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a
multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5
Survey Answer
Responses to Positive
Feedback Question (n=25)
Response to Negative
Feedback Question (n=25)
0 (0%)
0 (0%)
1 (4%)
7 (28%)
17 (68%)
18 (72%)
7 (28%)
0 (0%)
0 (0%)
0 (0%)
Relationship
Deteriorate Greatly
Deteriorate somewhat
Stay the same
Improve somewhat
Improve greatly
Interpreting Results
• Motivation to Learn
• Positive Feedback: either somewhat more (44%) or much more
(52%) inclined to learn about the subject. None reported a
decrease in interest in the subject.
• Negative Feedback: one-third would be either less inclined (24%)
or much less inclined (8%) to learn. Ten (40%) reported no
change in their level of interest, while the rest would be either
somewhat more inclined (20%) or much more inclined (8%)
Inclination to Learn Feedback Question (n=25)
Responses to Positive
Response to Negative Feedback
Question (n=25)
Much less inclined
0 (0%)
2 (8%)
Somewhat less inclined
0 (0%)
6 (24%)
No change
1 (4%)
10 (40%)
Somewhat more inclined
11 (44%)
5 (20%)
Much more inclined
13 (52%)
2 (8%)
Interpreting Results
• Motivation to Practice:
• Positive Feedback: most would spend somewhat more (60%) or much
more (12%) time practicing, some reported no change in (24%) or
less (4%) practice time.
• Negative Feedback: few would practice less (12%) or the same (16%);
most would spend either somewhat more (36%) or much more (36%)
time practicing.
Inclination to Practice
Responses to Positive Feedback Response to Negative Feedback
Question (n=25)
Question (n=25)
Much less inclined
0 (0%)
2 (8%)
Somewhat less inclined
1 (4%)
1 (4%)
No change
6 (24%)
4 (16%)
Somewhat more inclined
15 (60%)
9 (36%)
Much more inclined
3 (12%)
9 (36%)
Conclusions
• Survey results only a pilot- need more longitudinal study
to determine veracity of results
• Unclear relationship of of verbal feedback to skills
performance
• The subtle affects of verbal feedback on motivation to
learn and practice need to be further researched
References
•
Boehler ML, Rogers DA, et al. An investigation of medical students reactions to feedback: A randomized controlled trial. Med Educ. 2006
Aug;40(8):746-9.
•
Ende J. Feedback in clinical medical education. JAMA, 1983;250:777-81.
•
Elnicki DM, Kolarik R, Bardella I. Research Reports. Third year medical students perceptions of effective teaching behaviors in a
multidisciplinary ambulatory clerkship. Acad Med 2003; 78(8):5.
•
Branch WT Jr, Paranjape A. Feedback and reflections: teaching methods for clinical settings. Acad Med 2002:77(12.1):4
•
Sheehan TJ. Feedback: giving and receiving. J Med Educ. 1984; 59:913.
•
Isaacson JH, Posk LK, Litaker DG, Halperin AK. Resident perception of the evaluation process. Society of General Internal Medicine. J Gen
Intern Med 1995:10(Suppl): 89
•
Kogan JR, Confroti LN, Bernabeo EC, et al. Faculty staff perceptions of feedback to residents after direct observations of clinical skills. Med
Educ, 2012 Feb; 46 (2): 201-15
•
Papousek I, Paechter M, Lackner HK. Delayed psychophysiological recovery after self-concept-inconsistent negative performance
feedback. Int J Psychophysiol.2011 Dec; 82(3):275-82.
•
Bienstock JL, Katz NT, Cox SM, et al. To the point: medical education reviews—providing feedback. Am J Obstet Gynecol. 2007 Jun;196(6)
508-13.
•
Fundamentals of Laparoscopic Surgery Curriculum. http://www.flsprogram.org/