6If we don’t give feedback what is the learner gaining (or assuming)? The blindfold gameIf 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.
7‘Oh wad some Pow’r the giftie gie us To see oursels as others see us! It wad fre mony a blunder free usAnd foolish notionRobert Burns 1786
9So, what is feedback?Feedback is structured information that one person offers to another, about the impact of their actions or behaviour
10Why give feedback? Influence someone to change Recognise and reward Improve quality of workBuild and maintain relationshipsClarify expectationsInfluence motivationManage performance
11Why give feedback?Helps learners to maximise their potential at different stages of trainingRaises awareness of strengths and areas for improvementIdentifies actions to be taken to improve performance
12......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
14Linking feedback to the learning process The Kolb cycle 1984
15Hill 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 :-Where is the learner in terms of their learning, level reached, past experience, goals and understanding of learning needs’Learning goals in terms of knowledge, technical skills and attitudes
16The Pygmalion effectMight our expectations as teachers affect the performance of our learners?
17‘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’
18‘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.
19Treat a man as he is and he will remain as he is 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
25Principles of effective feedback (1) DescriptiveSpecificFocussing on behavioursIt should be for the learner’s benefitSharing information rather than giving adviceLimited to the amount the learner can use, not the amount you want to giveSolicited rather than imposedFeedback only about something which can be changed
26Principles of effective feedback (II) 9. Feedback should be timely and regular10. Focus on the positiveGive feedback privately (especially negative feedback)Linked to learner’s overall professional developmentStay in the ‘here and now’Use ‘I’ and give your experience of the behaviour
27Principles 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
28Principle 1 It should be descriptive Giving an accurate description of the behaviour you are talking aboutAvoiding ‘judging’ or ‘labelling’
29Principle 2. It should be specific Be clear about what aspect of performance or behaviour you want to talk aboutNot generalised.
30Principle 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)
31Principle 4 Feedback should be for the learner’s benefit
32Principle 5 Feedback should be sharing information Not giving of advice
33Principle 6 Don’t overload Identify two or three key messages that you summarise at the end
34Principle 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 offerNot imposed
35Principle 8 Give feedback only about something that can be changed
36Principle 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’.
51Pendleton’s rules Check learner is ready for feedback Let learner give comments /background on the material being assessedThe learner states what was done wellObserver(s) state what was done wellLearner states what could be improvedObserver(s) states how it could be improvedAn action plan for improvement is made
59The SET-GO Approach to Feedback, Silverman et al (1997)Describe what was Seen/experience; be descriptive, specific , non-judgementalProbe to discover what Else was seen/experienced; what happened next in descriptive terms?Trainee describes what was Thought at the time; reflect back to experienceClarify what Goal the trainee would like to achieve; use an outcome based approachExplore Offers on how to achieve the goal; take suggestions and discuss alternatives
60Additional cautions for trainers:- Parsloe (1995) Don’t take the relationship for granted, especially if you’ve worked with learner for some timeLearner may be in dependant or subordinate roleBe clear about expectationsAim for supportive, relaxed, informal environment
61Common pitfalls in giving feedback A negative emphasisA ‘flavour of the month’ approachA lack of confidentialityPoor communicationHaving no action or support
62Barriers to feedback process. 1) Difficulties in giving feedback Believing the feedback is negative and unhelpfulWorrying the other person won’t like youBelieving the other person can’t handle feedbackPrevious experience where no change occurred, or reaction was hostileFeeling feedback isn’t worth the risk
63Barriers to the feedback process 2) Receiving corrective feedback Having the urge to rationalise, since criticism can feel uncomfortableBelieving self-worth is diminished by suggestions for improvementPrevious experience where feedback was unhelpful or unjustified
64End on Ende‘The important things to remember about feedback in medical education are that:-It is necessaryIt is valuableAfter a bit of practice and planning it is not as difficult as one might think’
69More Hot Tips on FeedbackCongruency, 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” MethodTell 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 improveBe 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 feedbackDon’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 feedbackSay 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 choiceDon’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
70Common Pitfalls in Giving Feedback… things to avoid doing A negative emphasisIt 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" approachWhere 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 confidentialityFor 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 communicationIf 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 supportFor 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.
71Feedback skills Active listening Observation Clear verbal expression Structure your messagePlan and prepare your messageTimingSelf awarenessResilienceAssertiveness
73ReferencesHeskett EA, Laidlaw JM 2002 ‘Developing the teaching instinct’ Medical Teacher 24(3) 245-8
74BMJ 7200 Volume 318: Saturday 26 June 1999 Career focus Giving feedbackProviding feedback is central to training doctors. Jennifer King considers theoretical and practical aspects of this important skill for all who teach or appraise
75Principles of constructive feedback. Kurtz, Silverman & Draper 1998 Feedback should be descriptive rather than judgemental or evaluativeMake feedback specific rather than generalFocus feedback on behaviour rather than personalityFeedback should be for the learner’s benefitFocus feedback on sharing information rather than giving adviceCheck out interpretation of feedbackLimit feedback to the amount of information the recipient can use rather than he amount you’d like to giveFeedback should be solicited rather than imposedGive feedback only about something that can be changed
76Principles of constructive feedback Kurtz, Silverman & Draper 1998 Feedback should be descriptive rather than judgemental or evaluativeMake feedback specific rather than generalFocus feedback on behaviour rather on personalityFeedback should be for the learner’s benefitFocus feedback on sharing information rather than giving adviceLimit feedback to the amount of information the recipient can use rather than the amount we would like to giveFeedback should be solicited rather than imposedGive feedback only about something that can be changed
77Principles of feedback I(London deanery) Give feedback only when asked to do so or when your offer is acceptedGive feedback as soon after the event as possibleFocus on the positiveGive feedback privately, especially more negative feedbackIt needs to be part of the overall communication process and ‘developmental dialogue’. Use skills such as rapport, developing respect and trust with learnerStay in the ‘here and now’, don’t bring up old concerns or previous mistakes unless these highlight a pattern of behaviour
78Principles of feedback II Focus on behaviours that can be changed, not personality traitsTalk about and describe specific behaviours , giving examples, and without assuming motivesUse ‘I’ and give your experience of the behaviour (when you said, I thought you were.)When giving negative feedback suggest alternative behavioursBe sensitive to the impact of your message – feedback is for the recipient, not the giverConsider the content of the message, the process of giving feedback, and the congruence between verbal and non-verbal messagesEncourage 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))
79Principles of feedback III Be clear about what you are giving feedback on,and link this to learner’s overall professional developmentDon’t overload- identify two or three key messages that you summarise at the end
80What constitutes effective feedback? DescriptivePerformance focussedClear and directOfferedOwnedSpecificBalancedTimely and regularSolution-focussed
81Brown and Leigh’s rules for giving constructive feedback (from ‘The GP Educator’s handbook) DescriptiveSpecific or focussedDirected towards behaviour that can be changedTimelySelective( Suggestions rather than prescriptions)
82Criteria for effective feedback Descriptive - of the behaviour rather than the personalitySpecific - rather than generalSensitive - to the needs of the receiver as well as the giverDirected - 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
83Giving informal feedback As soon afterwards as practicalPositive, specific, and focussing on trainee’s strengthsNegative feedback should be specific, non-judgemental, and accompanied by suggestions for alternatives.Encourage learners to seek feedback themselves ‘Feedback works best when sought’Hesketh and Laidlaw 2003
84F. Hill‘Feedback to enhance student learning:- Facilitating interactive feedback on clinical skills’ Medical Teacher 24:245-8
85Nicol & Macfarlane 2006Formative assessment and self regulation in learners Studies in Higher education 34(i)