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Calvin Chou, Denise Davis, Ryan Laponis UCSF Department of Medicine Kara Myers UCSF Department of Obstetrics and Gynecology Stephanie Harman Stanford Department.

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Presentation on theme: "Calvin Chou, Denise Davis, Ryan Laponis UCSF Department of Medicine Kara Myers UCSF Department of Obstetrics and Gynecology Stephanie Harman Stanford Department."— Presentation transcript:

1 Calvin Chou, Denise Davis, Ryan Laponis UCSF Department of Medicine Kara Myers UCSF Department of Obstetrics and Gynecology Stephanie Harman Stanford Department of Medicine

2 Creative Commons License Attribution-NonCommercial-Share Alike 3.0 Unported You are free: to Share to copy, distribute and transmit the work to Remix to adapt the work Under the following conditions: Attribution. You must give the original authors credit (but not in any way that suggests that they endorse you or your use of the work). Noncommercial. You may not use this work for commercial purposes. Share Alike. If you alter, transform, or build upon this work, you may distribute the resulting work only under a license identical to this one. See http://creativecommons.org/licenses/by-nc-sa/3.0/ for full license.http://creativecommons.org/licenses/by-nc-sa/3.0/

3 Overview of the session Introductions (5 min) Interactive discussions: definitions, goals, brief literature review (15 min) Small group breakouts with accordion reconvenings (140 min) Final conclusions for feedback (10 min) Remediation panel (60 min)

4 Introductions Name Position(s) Where you work Learners you work with

5 Overview of the session Introductions (5 min) Interactive discussions: definitions, goals, brief literature review (15 min) Small group breakouts with accordion reconvenings (140 min) Final conclusions for feedback (10 min) Break (10 min) Remediation panel (60 min)

6 About feedback "Courage is what it takes to stand up and speak. Courage is also what it takes to sit down and listen"

7 Definition and Facts Feedback: specific, nonjudgmental information comparing a trainees performance with a standard, given with intent to improve performance Fact: Feedback is always being given, consciously or unconsciously, skillfully or carelessly Suggestion: Feedback is an expression of commitment to the relationship Van de Ridder et al, Med Educ 2008

8 Imagine a scenario Think about a learner Envision a scenario in which you would give feedback to that learner

9 Goals What you hope to gain from this workshop? (youll work on these in small group)

10 Brief Literature Review Optimal reinforcing:corrective comments ratio: 4:1 Students like praise as an ego boost but also want specific guidance when they make mistakes Tying feedback to learners goals Understanding the learners position helps Calibrating the amount of feedback Rudy et al, Eval Health Prof 2001; Kernan et al, Am J Med 200o; Hewson and Little, JGIM 1998; Sostok et al, Acad Med 2002

11 Feedback Steps Set up Gather Information / Observe ARTful Delivery of Feedback Bienstock et al, Am J Ob Gyn 2007

12 Overview of the session Introductions (5 min) Interactive discussions: definitions, goals, brief literature review (15 min) Small group breakouts with accordion reconvenings (140 min) Final conclusions for feedback (10 min) Break (10 min) Remediation panel (60 min)

13 Small Groups, Large Group Convene small groups for writing, skills practice Practice three individual components of feedback: Large group mini-didactic and demonstration Small group practice

14 Set-up Creating a permissive environment for maximal learning In context of learner-teacher relationship In the spirit of dialogue rather than downloading Features: Temporally close to event In accordance with learners goals: what are the characteristics of the most exemplary doctors you have seen? In accordance with learners readiness

15 Small Group Task 1 Sub-intros – name; what you have learned thus far, if anything, that is most alive for you?

16 Gather information Transcribe what is happening Verbal Nonverbal Record words and/or behaviors to give feedback about Avoid You were… Practice I saw…; I heard…; I noticed…

17 Feedback Steps Set up Gather Information / Observe ARTful Feedback Reinforcing Corrective Next Steps Bienstock et al, Am J Ob Gyn 2007

18 ARTful Skills Ask Self-assessment Can frame in terms of learners previously-stated goals Respond Depends on active listening Using empathic words can be helpful Tell Your own assessment and thoughts Behavioral and specific Can illuminate blind spots

19 ARTful Skills Ask Self-assessment Recall previously-stated goals from Set-Up Respond Depends on active listening Using empathic words can be helpful Tell Your own assessment and thoughts Behavioral and specific Can illuminate blind spots

20 ARTful Reinforcing Feedback Ask: What do you think youd like to keep doing? Respond: gently redirect learner from self-criticism, and take the opportunity to agree or reflect the learners self-assessment Tell: your own assessment (if anything to add) The ART cycle continues: ask for reactions to your feedback

21 ARTful Corrective Feedback Ask: What do you think youd like to stop doing? Respond, Tell (remain as nonjudgmental as you can!) Continue the ART cycle: ask for reactions to your feedback For challenging situations, try: Asking about intention (cultural sensitivity) Responding with empathy or a summary Telling your perception of how intention and impact differ

22 ARTful Next Steps Ask: What do you think youd like to start doing? Respond, Tell ARTful cycle For learners in high-stakes situations: Agree on action plan and accountability By when? What would you expect to happen if you cant / dont meet our agreement?

23 Summary Adapted from American Academy on Communication in Healthcare Bienstock et al, Am J Ob Gyn 2007 Set up Gather Information / Observe ARTful Feedback Keep (Reinforcing) Stop (Corrective) Start (Next Steps)

24 Quotation Without feedback, mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved incidentally or not at all. Ende, JAMA 1983

25 Overview of the session Introductions (5 min) Interactive discussions: definitions, goals, brief literature review (15 min) Small group breakouts with accordion reconvenings (140 min) Final conclusions for feedback (10 min) Break (10 min) Remediation panel (60 min)

26 Feedback Steps Set up Gather Information / Observe ARTful Feedback Reinforcing Corrective Next Steps Bienstock et al, Am J Ob Gyn 2007

27 NET GOALS

28 Respond Helpful to summarize briefly what learner has said, and to gently redirect self-criticism for now Use PEARLS tools to build relationship Partnership: Im happy to work with you on this Empathy: Sounds like it was frustrating to struggle Apology: Im sorry to hear that you had difficulty Respect: Thanks for sharing your perspective Legitimation: This is a really hard exercise Support: Lets see how I can help you with this


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