The Skills of Providing Constructive Feedback DR. MOHAMMED O. AL-RUKBAN Associate Professor Department of Family and Community Medicine College of Medicine, King Saud University

رحم الله من أهدى إليّ عيوبي

قال الرسول الكريم: المؤمن مرآة أخيه

Content… Objectives Q1. What is the definition of feedback? Q2. Why feedback? Q3. How to conduct a feedback ? Q4. What is the difference between feedback and evaluation?

Content… Q5. How frequent Feedback is used in our medical education and why? Q6. Who should give the feedback? Q7. Where and for what behavior? QQQQQ? Summary and conclusion

Objective... The aim of this presentation is to improve our skills of giving feedback to students and trainees

What is feedback?

Coined in 1940s by Rocket Engineers What is feedback? Coined in 1940s by Rocket Engineers

Feedback is a planned learning experience during which a person What is feedback? Feedback is a planned learning experience during which a person who performed a task is helped to improve his performance through emphasizing on things done well and others that need improvement and how?

Why feedback? Think about a situation in which you received feedback that impacted on you. Was it a positive experience or a negative experience? What specifically do you remember?

Why feedback? It is a very strong educational tool Without feedback ……………. mistakes go uncorrected good performance is not reinforced clinical competence is achieved empirically or not at all. Jack Ende, Feedback in clinical medical education JAMA.,1983

What Does the Research Say? Specific, descriptive feedback that focuses on success and points the way to improvement has a positive effect. (Davies, 2002) Clear, concise feedback matched to standards will promote student achievement. (O’Connor, 2002)

What Does the Research Say? Feedback generally produces positive results if teachers manage the form the feedback takes. (Marzano, Pickering, & Pollack, 2001) Students must be given the opportunity to apply the feedback by trying again. (Black & Wiliam, 1998)

What Does the Research Say? The most powerful single modification that enhances achievement is feedback. The simplest prescription for improving education must be “dollops of feedback ”. (Hattie, p 9)

How to conduct a feedback session? Trainee: Things he liked or did well.. Trainer: Things they liked or did well.. Trainee: Things to improve and how? Trainer: Things to improve and how? Trainer: Summarizes (positive points & specific suggestions for improvements)

Feedback should be: Timely (the most effective) Midpoint Feedback Feed forward START END

Feedback should be: Timely (the most effective) Interactive Short Specific Relevant Non-Threatening Non-judgmental

Which is more appropriate ? A- The antibiotic regimen chosen did not provide coverage for H-influenza. B- Your choice of the antibiotics indicates a lack of appreciation for the possibility of enterococcal infection.

Which is more appropriate ? A- You were great when you presented the topic. B- The case presentation gave me a useful picture of the presenting problem

Feedback should be: Non evaluative Objective appraisal of performance Not an estimate of trainees personal worth. In a proper setting and Climate. Include Suggestions for improvement

What is the receivers’ impression on Feedback? Adult Learners welcome feedback, especially when it is based on their performance and tailored to their goals. Knowles MS. San Francisco, Calif; 1980. Feedback, even corrective type, is seen as helpful and highly appreciated. Hewson MG, Little ML. J Gen Intern Med;1998.

What is the difference between feedback and evaluation? Feedback Evaluation Formative Summative Specific (not general) In descriptive (non evaluative) terms. Focus on the actions or decisions not the person or the decision maker.

is used in our institute? How frequent Feedback is used in our institute? Commonly Rarely Why?

Why Feedback not used frequently? Not use to it. Failure to obtain data. Observations are the currency of feedback. Teachers avoid hurting or embarrassment. Damage relationship.

Who should give the feedback? Anyone who is in a position to make a valid observation of the trainee’s performance and who is experienced enough with the clinical problem and the pedagogic problem.

Who is the least able to offer Feedback? The person administratively in charge. Third hand data.. e.g The chairman of the program (Dr- A) says to the resident : “ Dr. B said your six months ago knowledge is alright but your clinical skills need more work” ( The rotation finished around)

Where and for what behavior? History P/E Case presentation Ward round progress notes…..

TAKE HOME MESSAGES In most classrooms providing FEEDBACK are frequently underused! FEEDBACK is a very effective tool for a student and teacher to improve education. There is difference between FEEDBACK and EVALUATION.

THANK YOU QQQQQ???

Further Reading Attached papers Ende J. Feedback in clinical Medical Education. JAMA 1983, 250. Ferenchick G, Simpson D et al. Strategies for efficient and effective teaching in the Ambulatory care setting. Academic Medicine 1997,72 (4): 277-280. Steinert Y. Twelve tips for effective small group teaching in the health professions. Medical Teacher 1996, 18(3):203-207. A videotaped lecture by Dr. Basil Al Sheikh

Further Reading 2 Ron and Susan Zemke entitled “Adult Learning: What Do We Know For Sure” in Training magazine, 1995, volume 32(6):31-40. Harden RM, Crosby JR, Education Guide, The Good teacher is more than a lecturer. The twelve roles of the teacher. McLeod PJ, Harden RM. Clinical strategies for physicians. Medical Teacher 1985,7 (2):173-189 Book titled ?? “The Medical Teacher” by Prof. Harden