Promoting Excellence in Family Medicine NACT conference 2011 Feedback Dr Jill Edwards MSc FRCGP Dr Nicki Williams MSc FRCGP

Promoting Excellence in Family Medicine “Feedback” What is it?

Promoting Excellence in Family Medicine Feedback in Clinical Education Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance Van de Ridder et al 2008 What is Feedback in Clinical Education? Medical Education 42 no 2 p189

Promoting Excellence in Family Medicine Thoughts about feedback Function of feedback “Positive Feedback” and “Negative Feedback” Effective feedback

Promoting Excellence in Family Medicine Function of Feedback Motivate Encouragement To change To continue doing effective behaviour Developing self esteem Benchmarking How am I doing? Increasing insight, capability self awareness and effectiveness Sharing expectations

Promoting Excellence in Family Medicine Johari’s Window Known to selfUnknown to self Known to othersFREE SELF Open to self & others BLIND SELF Seen by others, but not by self Unknown to othersHIDDEN SELF Seen by self, but not by others UNKNOWN SELF Unseen by self & others

Promoting Excellence in Family Medicine Motivation Most people have a basic need to know how well they are doing The expectation of success is fundamental to motivation and effort Motivation and effort  when goal is perceived as almost certain or impossible

Promoting Excellence in Family Medicine The power of positive expectations “I shall always be a flower girl to Professor Higgins because he always 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 “ George Bernard Shaw Pygmalion

Promoting Excellence in Family Medicine Problems with feedback Doesn’t happen Positive and negative feedback doesn’t effect change in performance in a constant manner Poor feedback can damage motivation Poor feedback can effect self efficacy – promote learned helplessness

Promoting Excellence in Family Medicine RELATIONSHIP DIAGNOSTICS MANAGEMENT Professionalism Maintaining Performance, Learning & Teaching Primary Care Administration & IMT Community Orientation Maintaining an Ethical Approach to Practice Fitness to Practise Data Gathering & Interpretation Clinical Management Managing Medical Complexity Making a Diagnosis / Making decisions Communication & Consulting Skills Working with Colleagues & in Teams Practising Holistically WPBA competencies

Promoting Excellence in Family Medicine RCGP CSR Quality Management Pilot 250 Clinical Supervisors Reports (CSRs) 5.8% of the total submitted between 1 January and 31 March 2010 assessed by the External Advisors

Promoting Excellence in Family Medicine RCGP CSR Quality Management Pilot CSR acceptableCSR needs further information a) Free text comments are specific and constructive c) There is little or no formative feedback to the learner b) Where underperformance is noted or concerns are highlighted, free text comment is made d) Where grades are ‘borderline’ or ‘below expectation’, insufficient free text comment is made and little or no detail about concerns provided.

Promoting Excellence in Family Medicine RCGP CSR Quality Management Pilot There is little or no formative feedback to the learner: 51.6% Free text comments are specific and constructive: 44%

Promoting Excellence in Family Medicine Features of Effective Feedback Positive  Mutual Respect  Specific Praise or criticism  A genuine desire to help  Allowing time  Against previously discussed criteria  Learning contract Negative  Public humiliation  Comments on personality  No two way discussion  Lack of personal interest  Too general  Too little too late

Promoting Excellence in Family Medicine

Models of Feedback Pendleton’s Rules Sandwich approach Positive (reinforcing) v Negative (corrective) Regulatory focus

Bespoke Feedback

Promoting Excellence in Family Medicine Bespoke Feedback Depending on the regulatory framework (Higgins) Prevention – vigilance & concern with punishment – ‘have to’ – negative feedback Promotion – eagerness & concern for rewards – ‘want to’ – positive feedback Kluger AN & Van Dijk D. Feedback, the various tasks of the doctor, and the feedforward alternative. Medical Education 44 no 12 p1166

Promoting Excellence in Family Medicine Criteria for feedback 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 Timely Given as close to the event as possible Selective Addressing one or two key issues

Promoting Excellence in Family Medicine Effective Feedback Ineffective feedback Reduces the learner’s self respect X X Effective Feedback Preserves or enhances the learner’s self respect Feedback about good performance Feedback about performance that needs to be or could be improved

Promoting Excellence in Family Medicine Your turn! Gordon Ramsay giving feedback …

Promoting Excellence in Family Medicine So.. How did he do? 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 Timely? Given as close to the event as possible Selective? Addressing one or two key issues

Promoting Excellence in Family Medicine In Groups of three One ‘Gordon’, one ‘trainer’ feeding back to Gordon on his feedback and one observer. How was it for you? (Gordon then trainer then observer.) In the same group, try different ways to make it more effective Summarise learning points to the main group

Promoting Excellence in Family Medicine Learning points What might YOU do differently next time?

Supporting Excellence In Medical Education 9th National Multi-specialty Conference for Heads of Schools, Programme Directors, Directors of Medical Education 25 & 26 th January 2011 C O G P E D