Using the ARCH Feedback Model to Facilitate Teacher-Learner Collaboration and Enhance Self- Regulated Learning Skills A Workshop for the STFM Annual Spring Conference May 1-5, 2013 Baltimore, MD

Presenters Dennis Baker, Ph.D., Assistant Dean for Faculty Enrichment, ACOM Greg Turner, Ed.D., Associate Dean for Faculty Development, FSUCOM Suzanne Bush, M.D., Clerkship Director for OB/GYN Pensacola Campus 2

We have nothing to disclose. 3

Agenda Introductions and Overview Your feedback experiences Review of Literature on Feedback Presentation and Discussion of the ARCH Model Scripted Role-Play Followed by Discussion Viewing of ARCH Videos and Discussion Group Practice Using ARCH Discussion of How Participants Will Use ARCH Model 4

Learning Objectives 1.Name and briefly explain the components of the ARCH feedback model. 2.Describe strategies for making each component of the ARCH model effective. 3.Given written or video examples of the ARCH model, identify how the components of ARCH were exemplified. 4.Apply ARCH model components to give the workshop presenters feedback. 5.Identify strategies for using the ARCH model in clinical teaching setting. 5

Your Feedback Experiences (10 minutes) Describe a situation you have experienced as a teacher or learner in which feedback given or received was helpful or harmful. Work in small groups and share stories Pick one story to share with all Please take no more than 10 minutes 6

Effective Feedback Characteristics Specific Well-timed Based on reliable information (e.g. direct observation) Appropriate quantity Descriptive, non evaluative language Given in collaborative spirit Emotions of teacher and student considered Involves learner self-assessment Extended by goal setting, planning and coaching 7

Literature on Feedback 1.With regard to feedback, there is a difference between what teachers report they deliver and what students report they receive. 2.Clinician teachers indicate they want training in how to give feedback. 3.Feedback improves learning. 4.Students identify “giving feedback” as a quality of good teachers. 5.Feedback is often not given effectively or not at all. 8

Reasons for Ineffective Feedback 1.Poor ability of learners to self-assess 2.Influence of learners’ negative reactions to feedback 3.Lack of learners’ metacognitive skills development 4.Seeking feedback may be viewed as weaknesses 5.Critical components of the feedback process absent: Self-assessment Goal Setting Action Planning Bing-You, RG And Trowbridge, RL Why medical educators may be failing at feedback. JAMA. 2012;302(12): Need: A feedback model that addresses these areas! 9

Critical Components of a Feedback Model Interactive feedback methods, including students’ self-assessment and an action plan for improvement with follow-up are critical components of effective feedback (Hattie & Timperley, 2007) but underutilized in feedback to students and residents (Holmboe, et. al. 2004). 10

1.Have an orientation session with the student at beginning of learning experience and set expectations including expectations for feedback. 2.Make expectations clear 3.Aware of what the learner needs to learn 4.Approachable (aka “safe”) 5.Interested in learner as a person 6.Organized Approach (have a teaching routine) – Do you have a common routine/approach? Effective Clinical Teachers 11

7.Role Model (What do you want to role model?)Role Model 8.Knowledgeable 9.Provide clear explanations 10.Facilitate clinical reasoning skills 11.Provide time for discussion 12.Question effectively Various levels of thinking elicited Uses “wait-time Effective Clinical Teachers 12

Effective Clinical Teachers

“Paradigm” Shift How do most people respond to the phrase, “Let me give you some feedback.” The term “feedback” has a negative valence, especially in the world of medical training. Suppose the word “feedback” was erased from everyone’s vocabulary. What word or words would we substitute for feedback. – “You have 3 to 5 seconds to respond.” 14

15 What type of feedback would typically be given? “Your blood pressure is out of control.”

The Paradigm Shift “The time has come to reframe the feedback discussion in order to guide learners’ developing competence.” Hauer, KE. & Kogan, JR., Realising the potential value of feedback. Medical Education 2012; 46:

The ARCH Feedback Model The ARCH Model Guidance 17

ARCH Model A = Allow for Self-Assessment R = Reinforce correct behavior/knowledge/attitudes C = Correct incorrect behavior/knowledge H = Help learner with improvement plan 18

The Importance of Self-Assessment 19

A A = Allow/Ask for self-assessment Create safe climate. Ask for strengths and ask for something needed to improve on Use learner’s self assessment as launching pad for moving to Reinforcement step. 20 ARCH

R R = Reinforce correct attitudes/knowledge/thinking/skills Address learner’s self-assessed strengths before addressing strengths you identified. Explore with learner how s/he knows something is being done well and how improvement occurred. Be specific when stating things done well and why those things are important. 21

ARCH C C = Correct incorrect behavior/knowledge Address learners self-assessed areas for improvement first. Ask learning how he/she might improve on his self-assessed weakness. State something the learner can improve on that he/she did not identify and explore improvement strategies with him/her. Use descriptive language; not judgmental language. Explore improvement strategies with learner. 22

H H = Help learner with improvement plan. Improvement plan should evolve from the conversation on things to improve/correct. Discuss various ways to improve. Plan collaboratively. Be a partner with the learner. Help learner create S.M.A.R.T.E.R. goals and action plans. Action plan should be simple. Have learner restate plans and set stage for coaching as needed. 23 ARCH

Scripted Illustration of ARCH A scripted ARCH model will be read by 2 participants in front of the group with one being the teacher and the other being the learner. Participants will be grouped into the categories of A and R and C and H Each category group will identify how the 2 script readers illustrated the behaviors. 24

Viewing of ARCH Video Examples and Discussion Video 1 ARCH1 no titles Video 1 Video 2 ARCH 2 no titles Video 2 Video 3 AR (Suzanne/Suzanne) Video 3 Video 4 ARCH elaborated Video 4 Video 5 ARCH hallway Video 5 25

Audience Feedback to Presenters Using ARCH 26

Discussion of strategies to implement model in clinical teaching environment 27

Thank You For Attending! We are honored that you choose to attend this session. If you implement the ARCH model, please send us and to tell us how it went. 28