Giving Educational Feedback An Interactive Skills Development Workshop with Feedback as the Content Element Felise B. Milan, MD Michael J. Reichgott, MD, PhD

Goals of this workshop are to: Train faculty in educational methods for developing a workshop on giving feedback to medical students. Demonstrate a model of interactive small group skills teaching. Demonstrate use of supportive educational materials for a feedback workshop. Present content elements pertaining to the use of formative feedback in medical education.

Learning Objectives Participants will: Know the elements of giving feedback. Demonstrate the skills of giving formative feedback using interactive methods. Initiate a plan to develop a workshop at his/her site using the educational materials provided.

Basic feedback Feedback refers to information describing a students performance in a given activity that is intended to guide their future performance in that same or in a related activity. It is a key step in the acquisition of clinical skills.* * Ende, J. MD, Feedback in Clinical Medical Education, JAMA 1983; 250:

Feedback as Coaching Basic feedback is analogous to coaching in any setting. Performance is observed and the elements are evaluated. The coach gives feedback (instruction) to the student with respect to elements of behavior or performance that require improvement.

Principles of Basic Feedback Feedback should be delivered in private. Feedback should be planned in advance. Feedback should be performance specific. Feedback should not pertain to personal characteristics. Feedback should be descriptive, not judgmental. Feedback should be given timely to the observation it addresses. Feedback should be focused on specific observations. Feedback should be based on first-hand observation and/or written evaluations. Feedback should balance positive and negative comments. Feedback should benefit the receiver, not soothe the giver.

The Feedback Sandwich The Feedback Sandwich maintains a trust environment: State (based on observation): What was done well… What could be changed or improved… How improvement might be achieved…

The Expanded Feedback Sandwich What do you think you did well? What do you think needs improvement? (the student is usually on target) This is what I saw that went well. This is what I saw that needs improvement. (generally there is concurrence) How would you try to improve? Here are some suggestions you might try. Which of these would you like to try first?

Advanced Feedback Required when responding to a substantially negative aspect of student behavior or performance. Can not be entirely objective way. Higher level of tension than basic feedback Strong possibility that the student will demonstrate defensive reaction.

PEARLS Partnership for joint problem-solving Empathic understanding Acknowledgement Respect for values and choices Legitimation of feelings and intentions Support for efforts at correction

Precontemplation Contemplation Preparation Maintenance Relapse Action Transtheoretical Model

PrecontemplationNot aware Identify understanding Provide information Provide support ContemplationAware but ambivalent Identify goals Define discrepancy between goals and performance/behavior Emphasize self-motivation PreparationCommitte d to change Support commitment Plan strategies ActionHas initiated change Identify resources Identify barriers Anticipate relapse MaintenanceChange is stable Support behaviors Foster development of new goals RelapseUndesired behaviors recur Identify relapse Review motivation Review resources Develop new strategies Stages of Readiness to Change