1. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 1 FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT

2. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS TODAY’S SESSION FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 2

3. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS OBJECTIVES  Describe, in your own words, the differences between feedback and evaluation  Describe at least three common barriers to providing constructive feedback in the clinical environment  Describe positive feedback strategies that are appropriate for the clinical environment, with an emphasis on appropriate timing  Apply the eight step constructive feedback process in a clinical environment  Evaluate the effectiveness of feedback through learner's change in behavior FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 3

4. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 4 WHAT IS FEEDBACK?

5. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK VERSUS EVALUTION Evaluation, which is  Summative, reflective of a composite of multiple exposures and generally completed at the end of a period interaction  Intent is to grade or rank a trainee relative to his or her peers or to a gold standard  Formal, generally standardized, and often high-stakes Feedback is:  Formative, that is, given in a timely enough manner that it can affect performance BEFORE evaluation  Intent is to reinforce positive behaviors and improve or change negative behaviors  May be either formal or informal FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 5 Aagaard E, Czernik Z, Rossi C, Guiton G. Giving Effective Feedback: A Faculty Development Online Module and Workshop. MedEdPORTAL Publications; 2010.

6. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS Examples  Year end performance review FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 6 Evaluatio n  Mid-rotation check in Feedback  Shelf exams Evaluation  Comments on a non graded case write up Feedback

7. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS “... Information that a system uses to make adjustments in reaching a goal ” Ende J. JAMA 1983;250:777-781. FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 7 FEEDBACK

8. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK Specific information about a trainee's observed performance, based upon a goal/standard, given with the intent to improve the trainee's performance. FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 8 NEED CITATION.

9. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS  Key to experiential learning  We are poor self-assessors  We know the intentions of our actions, but not the effects FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 9 WHY FEEDBACK?

10. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS EFFECTIVE FEEDBACK  Based on shared goals  Well-timed and expected  Based on first-hand data  Limited to remediable behaviors  Deals with specifics  Deals with actions and impact, not intentions FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 10 Adapted from Ende J. Feedback in Clinical Medical Education. JAMA. 1983;250(6):777-781.

11. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 11 BARRIERS

12. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS What is Most Challenging about Teaching?  “Finding time on a busy service”  “Not enough time”  “Teaching in a timely manner”  “I’m not the best at teaching ‘on the fly’ so to find designated time is hard” SORT OUT CITATION Resident RAE Survey 2010 FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 12

13. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS POSSIBLE BARRIERS  Uncomfortable with confrontation  Belief that things will improve on their own  Lack of time  Uncertainty with own knowledge base  Belief that it is too late in rotation  Waiting for a pattern to develop  Learner has a “difficult” personality  Timing on the wards FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 13

14. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 14 STRATEGIES

15. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS VIDEO CLIP - STRATEGIES FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 15

16. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS STRATEGIES  Schedule a mid-rotation session with learners so they can improve under your guidance What is easy, what have you found to be challenging?  Label feedback as feedback  Focus on the behaviors and impact, not intentions  Limit your suggestions per encounter: 2-3 important points  Create a Plan and schedule a time for follow-up: I have some suggestions to help you improve… FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 16

17. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS PREPARATION  Setting: –In private –Without interruptions  Timing: As close to event as possible Make an appointment if possible, if not create some in his schedule Make sure learner is ready to hear it –Not being paged –Not distracted –Not distraught FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 17

18. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 18 EIGHT STEP APPROACH TO EFFECTIVE FEEDBACK

19. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS 8 STEP APPROACH TO EFFECTIVE FEEDBACK Step 8 - Recognize Achievements with Positive Feedback. Step 7 - Agree on the Follow-Up. Step 6 - Summarize the Discussion. Step 5 - Ask the Medical Student for a Plan. Step 4 - Ask for the Medical Student’s Input. Step 3 - State the Specific Issue of Concern. Step 2 - Greet the Medical student. Step 1 - Set Up the Discussion. FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 19 Smith, A. (2014, July 2). Eight Step Approach to Effective Feedback. (Weblog Entry). SmithCulp Consulting. Retrieved from: http://smithculp.com/2014/07/eight-steps-effective-constructive-feedback/

20. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS If timing is an issue...  Never too early or late in rotation to give feedback  Make feedback a regular and expected occurrence  Address issues when they arise and are fresh on your mind  Keep feedback brief by focusing on specific behavior/event/issue and what learner can do differently FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 20

21. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 21 CASE STUDY

22. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS CASE Jack is a third year medical student assigned to your office. On the first day you observe him drawing blood. You watch him trying to find the vein but is quite rough about it, which causes the patient to jump and say to jump and say “Ouch”. Thinking this is perhaps due to nervous jitters on the first day, you say nothing. Two weeks later, you observe the same exact technique with the same results – patient discomfort. FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 22 ADAPTED FROM Cox, S. Feedback and Evaluation. AustinGME.org. Retrieved from: http://www.austingme.com/templates/GraduateMedicalEducation/Assets/feedback_and_evaluation.pdf

23. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 23 CLOSING THE FEEDBACK LOOP

24. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS VIDEO CLIP – CLOSING THE FEEDBACK LOOP 1 FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 24

25. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS VIDEO CLIP – CLOSING THE FEEDBACK LOOP 2 FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 25

26. FACULTY DEVELOPMENT FOR CLINICAL EDUCATORS Key Takeaways  Direct = Clear  Be specific  Timely  Make a plan – use the Eight Step Approach to Effective Feedback FEEDBACK SKILLS FOR THE CLINICAL ENVIRONMENT 26