Residents as Teachers Loyola University Medical Center Stritch School of Medicine Graduate Medical Education Session 2

The Fine Art of Feedback

Intended Learning Outcomes Describe giving, receiving, and soliciting feedback in more detail Explain the interactions between giving, receiving, and soliciting feedback Identify barriers that prevent effective feedback Learn advanced techniques for giving, receiving, and soliciting feedback

How do you know you’re doing a good job? “When you don’t call me into your office, I must be doing a good job.” “I must be doing okay because there haven’t been any speeches about patient safety lately.” “I must be doing okay because you always tell me when I make too many errors.” “When you don’t send my reports back, I know I’m doing a good job.” “When you don’t look at me and shake your head, I know I’m doing a good job.”

Giving Feedback Receiving Feedback Soliciting Feedback “Lip service” “Demotivation” “Justification” Feedback Triad

Why Use Feedback? Learners who get effective feedback: – do significantly better – develop better judgment – learn faster Learners rate feedback as one of the most important qualities of a good teacher Most learners want more feedback on their clinical skills Feedback helps everyone

Arts & Crafts What is the main reason you do not get feedback more often? How do you typically react when receiving feedback? What’s the main reason why you don’t solicit feedback more often?

First, teachers need to undertake effective instruction… …Feedback is what happens second

Before Giving Feedback Have you communicated your expectations? Have you asked how the learner wants to get feedback? Have you conducted an orientation? Have you probed learner’s knowledge, skills, and abilities? Have you checked learner’s experience?

Two Types of Feedback Informal –Spontaneous –Unplanned –Brief Formal –Scheduled –Planned –More time

Feedback Triad Giving Feedback Receiving Feedback Soliciting Feedback

Definition of Giving Feedback Specific information provided by another source with the intent to improve performance or understanding The art of observation (of actions) and description (of outcomes)

Activity Think about the most recent time you received feedback from a teacher What was the event/situation? What specifically did they tell you? How did you take it? Write your answers on the index card provided

Levels of Giving Feedback TASK How well tasks are understood and/or performed Process The main process needed to understand and/or perform tasks Self- Regulation Self-monitoring, directing, and regulating of actions Self Personal evaluations and affect (usually positive) about the learner

Feedback Techniques Ask learner how she/he wants feedback Based on direct observation Ask learner for focused self-assessment Describe what you saw

Feedback Techniques Make the feedback very focused Specific behavior amenable to change Effectiveness/outcomes of behaviors Actions not inferences Value to receiver Develop joint action plan Follow-up

Activity Find a partner 30 seconds to: Think of something you like about your partner’s outfit One way the outfit could be improved Each partner tells what you like about the outfit, then says “but” then tell how the outfit could be improved Now repeat what you just said to your partner with the word “and” instead of “but”

Formal or Corrective Feedback Think it through first Control your emotions Anticipate reaction Private settings Explain the reason for the feedback Focus on actions/behaviors Supported by objective examples and direct observation Stay calm, use conversation voice

Formal or Corrective Feedback Actively listen to responses Clarify any misunderstandings Plan to move forward

“ Giving” Review Set a good foundation Teaching, expectations, orientation Focus the feedback Learner self-assessment Describe what you saw Going forward Where am I going? How am I doing? Where to next?

Feedback Triad Giving Feedback Receiving Feedback Soliciting Feedback

InformationSender Receiver Environment Timely Video/Written/ Verbal Goal – oriented Specific Descriptive Action plan Credibility Characteristics Behavior Delivery Respect Expertise Direct observation Objective Mentally ready Fits goals/objectives Useful Personal health Self-perception Prior KSA Motivation PerceptionFilter Private/Public Outpatient/Inpatient/OR Individual/Group Receiving Feedback

Activity Need a volunteer Warning No physical strain or pain May be mental anguish or feelings of resentment Effects won’t last more than 10 minutes

Receiving Feedback Will it help you obtain your goal? Listen to everything said—don’t interrupt Don’t defend, contradict, argue, or interrogate Ask for clarification if needed Accept it as one bit of data

Feedback Triad Giving Feedback Receiving Feedback Soliciting Feedback

Feedback Rich Environment Mutual accountability Willingness to learn No fear No surprises Truthfulness Self-responsible language Coaching

Soliciting Feedback: Receiver Request feedback early Highlight exactly what you are looking for Choose specific people Make sure it is directly related to your goals Use helpful opening phrases (“I think I missed the patient’s reaction. What do you think?”) Ask for recommendations Never compare the feedback from others openly Thank them for the information Decide what to do with their input Consider it as a single data point If you do use the feedback, tell them

Soliciting Feedback: Sender Create a supportive atmosphere Realize the person is asking for guidance, not criticism Clarify what the person wants feedback on Listen to their self-assessment and respond accordingly When finished, ask if that was what they wanted to know Respond with respect Help the person create an action plan: don’t tell them what to do Follow up in the future

Barriers to Giving Feedback “The learners already know how they’re doing.” “I don’t have time.” “That must have been an anomaly.” “I’m not used to this. I feel awkward.” “Learners get defensive.” “The learner isn’t ready to receive feedback.” “Who/what do I compare them to?”

Take Home Points Giving Feedback Teach first Be focused Receiving Feedback Active listening A single data point Soliciting Feedback Ask specifically Ask when you’re ready to receive