School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Feedback Jonathan Silverman Aarhus 2012

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE 1.Identify the problems you face in providing feedback 2.Principles of feedback 3.Avoiding defensiveness 4.Summary of take-home strategies Feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE 1.Identify the problems you face in providing feedback Feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Pairs Somebody you don’t know so well Talk about your experience the difficulties of feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE 1.Identify the problems you face in providing feedback 2.Principles of feedback Feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE What is feedback? Feedback is the art of observation (of actions) and description (of outcomes)

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Purpose of feedback to provide information about someone’s performance intended to guide future performance designed to influence, reinforce, or change behaviour, concepts or attitudes

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Gathering data for feedback Learners don’t perceive feedback as valid unless based on data Observation precedes feedback Data should be first hand (or if not, triangulated) Data about behaviours, not inferences

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE A very difficult job for feedback first you need data firstly identify what you want to feedback about

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE A very difficult job for feedback first you need data firstly identify what you want to feedback about now a demonstration of how now remodel how that was done

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Observation and Feedback Feedback tips: Start with learner agenda –Ask learner what feedback would be helpful to them? What were they trying to accomplish? Did they feel they accomplished it? What skills might assist in reaching objective?

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Observation and Feedback Feedback tips continued: Be behaviorally specific Describe what you observed and relate to objectives Balance feedback between what could be improved and what was effective Starting with learner agenda means areas for improvement may go first Limit amount of feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Give feedback as soon after the event as possible Give feedback only about something that can be changed Make feedback specific rather than general, with concrete examples Use “I” and give your experience of the behaviours Focus your feedback on behaviour rather than personality Limit feedback to the amount of information that the recipient can use rather than the amount you would like to give Your feedback should be for the learner’s benefit, not for yours Check the interpretations and consequences of your feedback Principles of GIVING constructive feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE 1.Identify the problems you face in providing feedback 2.Principles of feedback 3.Avoiding defensiveness Feedback

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Defensive versus supportive climate DescriptionEvaluation Problem Orientation Control Spontaneity (flexibility) Strategy (hidden agenda) Empathy (involvement) Neutrality (indifference) Equality Superiority Provisionalism (tentativeness) Certainty (dogmatism).

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Start with the receiver of feedback, their agenda, their self- assessment Give feedback that is descriptive rather than judgmental or evaluative Give balanced feedback – what worked and what could be done differently Specific behaviour amenable to change Look at outcomes and alternatives Ends with an action plan Follow-up A plan

Principles of agenda-led outcome-based analysis Organising the feedback process Start with the learner’s agenda ask what problems the learner experienced and what help he would like from the rest of the group Look at the outcomes learner and patient are trying to achieve thinking about where you are aiming and how you might get there encourages problem solving - effectiveness in communication is always dependent on what you and the patient are trying to achieve Encourage self assessment and self problem solving first allow the learner space to make suggestions before the group shares its ideas Involve the whole group in problem solving encourage the group to work together to generate solutions not only to help the learner but also to help themselves in similar situations

Principles of agenda-led outcome-based analysis Giving useful feedback to each other Use descriptive feedback to encourage a non- judgmental approach descriptive feedback ensures that non-judgmental and specific comments are made and prevents vague generalisation Provide balanced feedback encourage all group members to provide a balance in feedback of what worked well and what didn’t work so well, thus supporting each other and maximising learning - we learn as much by analysing why something works as why it doesn’t Make offers and suggestions; generate alternatives make suggestions rather than prescriptive comments and reflect them back to the learner for consideration; think in terms of alternative approaches Be well intentioned, valuing and supportive it is the group’s responsibility to be respectful and sensitive to each other

Principles of agenda-led outcome-based analysis Ensuring that analysis and feedback actually lead to deeper understanding and development of specific skills Rehearse suggestions try out alternative phrasing and practice suggestions by roleplay - when learning any skill, observation, feedback and rehearsal are required to effect change Value the interview as a gift of raw material for the group the interview provides the raw material around which the whole group can explore communication problems and issues: group members can learn as much as the learner being observed who should not be the constant centre of attention. Opportunistically introduce theory, research evidence and wider discussion offer to introduce concepts, principles, research evidence and wider discussion at opportune moments to illuminate learning for the group as a whole Structure and summarise learning so that a constructive end point is reached structure and summarise the session using the Calgary-Cambridge guides to ensure that learners piece together the individual skills that have arisen into an overall conceptual framework

School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE 1.Identify the problems you face in providing feedback 2.Principles of feedback 3.Avoiding defensiveness 4.Summary of take-home strategies Feedback