Resident Educator Development The RED Program A Residents-as-Teachers Curriculum Developed by Heather A. Thompson, MD

The RED Program Team Leadership How to Teach at the Bedside The Microskills Model: Teaching during Oral Presentations How to Teach EBM The Ten Minute Talk Effective Feedback Professionalism

Resident Educator Development (RED) Program Effective Feedback Resident Educator Development (RED) Program

Take a moment and think of a time when you received USEFUL feedback Take a moment and think of a time when you received USEFUL feedback. What made it useful? Then take a moment and think of a time when you received UNHELPFUL feedback. Why was it not helpful? Have the residents jot down ideas on a piece of paper.

Real Life Examples “I felt that the feedback was a little too ‘nice’. That is, it did not pinpoint and specifically target any of my weaknesses. Don't be afraid to be a little more blunt about weaknesses”. From our electronic evaluation system, “E*Value”.

Real Life Examples “I received my evaluation at the end of the rotation and was shocked to find that I was rated as “below average” in medical knowledge, physical exam skills and on presentation. I have a problem with this. 1) I had no idea that my performance was anything but satisfactory. I was never told that there was a problem. When I asked, I was told I was doing fine. 2) Nobody EVER watched me perform a physical – how could I be rated on this? 3) how am I supposed to change what I’m doing now that the rotation is over – what’s the point of telling me now? 4) I don’t even know what I did that makes me below average.” Another E*Value example.

Objectives Discuss the important elements in the process of giving effective feedback, including the INSIGHT model List the elements of the Pendleton Rules Review the “ORIME” method Practice giving feedback using videotape Objectives for our session.

Real Life E*value: In general, students rate our residents highly in terms of overall teaching skills However, lower scores are consistently noted in the area of feedback; similar trends noted for attending physicians Students and interns will often ask you “How am I doing?” People need more than “Fine” Another way to point out that our feedback skills need improvement.

Effective evaluation and feedback Set it up correctly (you can’t evaluate what you don’t observe) Watch and evaluate Debrief (INSIGHT, ORIME, Pendleton process) On a clinical rotation, we are doing #1 and #2 every day. It’s #3 that often gets overlooked and forgotten.

HOW to give effective feedback Comfortable for all involved (consider timing, location) Elicit opinion of the person receiving the feedback Establish joint goals and boundaries Not too much feedback (2-3 suggestions at most) Relate to specific behaviors, not the person “When you come in late, it disrupts the flow of patient care” NOT “You’re always late. You’re lazy.”

HOW to give effective feedback Make observations, not assumptions Give reactions, not judgments Use specific examples Offer suggestions for improvement; be constructive USE A SET ORDER OF DISCUSSION

“INSIGHT” Approach Inquiry Needs Specific feedback Interchange Goals Help Timing of follow-up session

INQUIRY How does the learner think things are going? Listen to the learner’s needs in detail. Listening attentively and thoroughly before commenting may be all you need to do, especially for minor/temporary problems. ?

NEEDS What does the learner feel s/he needs during this rotation? Ask the learner to define own learning needs. Learners accept feedback better when they feel the teacher has first understood their perspectives.

SPECIFIC FEEDBACK Give your constructive feedback as specifically as you can. Start with specific, positive feedback. Learner-centered is better. Feedback “sandwich”: Positive/Negative/Positive Verify the learner’s understanding of the feedback you’ve given.

INTERCHANGE How can you best balance the learner’s needs with the team’s needs? You may need to “think outside the box” to reach a “win-win solution”.

GOALS State any new goals you’ve just reached, or review existing goals. Verify that you both understand and agree on these goals.

HELP Do any serious problems merit a “learning consultation”? Chief residents Attending physician Program Directors Clerkship Directors Learning specialist Employee assistance program Others

TIMING OF FOLLOW-UP SESSION Any final questions or comments? When would you and the learner like to meet again to go over how things are going?

Pendleton’s Rules 1. Subject gives positive aspects 2. Observer gives positive aspects 3. Subject gives areas for improvement 4. Observer gives areas for improvement “Positive/Positive, Negative/Negative” This is a simple, set order of discussion that works very well, allows for a productive discussion to occur, and lessens the stress surrounding verbal face to face feedback.

Why Pendleton’s Rules Work 1. Subject speaks first gives the person being evaluated a feeling of control 2. Positive comments first lessens anxiety 3. Subject often identifies exact same issues! 4. Conversely—if subject has no insight, outside help might be in order

ORIME O: Observer (passive) R: Reporter (data gathering) I: Interpreter (differential diagnosis) M: Manager (formulates a treatment plan) E: Educator (reads up on a topic, teaches the team) Summarize where they are at, what it takes to get to the next level An alternative is to relate to the learner where they are at on this scale, and what it takes to get to the next level. ORIME is very intuitive and works for students, residents, even attendings!!

Video Clip Watch the video: choose 1. The Rambling Med Student. This student gives a poorly organized oral presentation to the attending. 2. The Intern Interview. This intern takes a history from the patient with a less than caring bedside manner. 3. The Renegade Intern. This intern intubates a patient on call without discussing the case first with his supervising resident. After this exercise, open it up for discussion—how did it go? Which did they prefer, INSIGHT, Pendleton’s rules, or ORIME?

Video Clip Split into pairs. One will play the role of the senior resident, one the role of the medical student or intern. Practice giving feedback: what would you say to this person to help improve the situation? Try using ORIME, or Pendleton’s Rules. After this exercise, open it up for discussion—how did it go? Which did they prefer, INSIGHT, Pendleton’s rules, or ORIME?

Objectives Discuss the important elements in the process of giving effective feedback (INSIGHT) List the elements of the Pendleton Rules Review the ORIME method Practice giving feedback Summarize by relating back to the objectives, and you’re done.