1. Pharmacy Precepting Pearls of Practice Providing Criteria-Based Feedback
Lanita S. white, pharm.d.
Assistant professor, department of pharmacy practice
Director, 12th Street health and wellness center
University of arkansas for medical sciences

2. Objective
Explain how to provide timely, constructive, and criteria-based feedback effectively.

3. What is it and why do we do it?

4. A Few Definitions… Provide
Supply; Make adequate preparation for; Make available for use
Criteria
A principle or standard by which something may be judged or decided
Base
Have as the foundation for; Use as a point from which development can occur
Feedback
Information about reactions to a product, a person's performance of a task, etc., used as a basis for improvement

5. What is Criteria-Based Feedback?
Making available for use, by the student or resident, information about performance of assigned tasks to be used as a basis for improvement guided by the principles and standards set forth by the college or residency program.

6. It is not…
Encouragement – Vague and does not focus on students’ skill development
Evaluation – Renders judgment, often occurs at the end of an activity (summative) and hinders remediation, is often expressed in a normative fashion comparing students, and can be vague
Constructive criticism – Describes the negative behaviors or actions of another and the effects that this behavior has on others; is grounded in empathy but it can emphasize the negative and ultimately create communication barriers
Self-reflection – Without feedback may not help students notice behaviors that they need to improve
Encouragement:
“You did a good job” is encouragement (Preceptors tend to use this statement when they feel uncomfortable discussing poor performance)

7. Reminder – It is…
Making available for use, by the student or resident, information about performance of assigned tasks to be used as a basis for improvement guided by the principles and standards set forth by the college or residency program.

8. Why is it necessary to do this?
ACPE – Accreditation Council for Pharmacy Education (2016)
(Released February 2015)
Didactic Curriculum:
Standard 24: Assessment Elements for Section I: Educational Outcomes
Standard 25: Assessment Elements for Section II: Structure and Process
Advanced Pharmacy Practice Experience:
Appendix 2: Expectations within the APPE curriculum
Colleges and schools assess student achievement of APPE competencies within their assessment plans using reliable, validated assessments. Formative feedback related to specific performance criteria is provided to students throughout the experience. At a minimum, performance competence is documented midway through the experience and at its completion.
Didactic Curriculum:
Standard 24 (assesses educational outcomes) - includes an assessment of student readiness to enter APPE’s, provide direct patient care and contribute as a member of an interprofessional patient care team
Standard 25 (assesses structure and process) – includes an assessment of clinical reasoning skills and APPE readiness
APPE’s:

9. Why is it necessary to do this?
ASHP – American Society of Health-System Pharmacists
(Released September 2014)
Standard 3: Design and Conduct of the Residency Program
Standard 3.4: Evaluation
Initial Assessment
Formative (on-going, regular) assessment
Summative Evaluation
Resident’s Development Plan

10. Student vs. Resident… What’s the difference?

11. Student or Resident – Where should they be, what should they know?
Learning where to find the information
Reviewing basic concepts of disease states
Learning how to put pharmacy school knowledge into a usable format
Should be able to manage several patients/tasks with practice
RESIDENT
Should know where to find or how to find it
Should be able to teach basic concepts of disease states
Learning how to put pharmacy school knowledge into a usable format
Should be able to manage several patients/students/tasks

12. Providing Feedback

13. Tips for successful feedback sessions
Be prepared with clear examples and notes for clarity
Open meeting effectively
Encourage participation and self- assessment
Reinforce desired behaviors
Clearly define undesired behaviors
Problem solve together, provide suggestions as preceptor
Assess recipient’s understanding and acceptance of the feedback
Allow for questions and clarification
Acknowledge perspective and feelings
Close the meeting effectively
Before starting you will do the things Dr. Young and Waggoner have discussed including:
Establish a relationship, open communication and common vocabulary
Evaluate based on defined and expressed expectations
Open meeting effectively
Assess recipient readiness, promote rapport
Establish agreed upon purpose of the meeting
Close meeting effectively
Summarize positives and areas/methods for future growth
Make plans with recipient to follow-up / assess progress

14. Tips for successful feedback sessions
Be aware of yourself and how you are perceived:
Demonstrate positive regard for recipient
Involve recipient in process
Focus on specifics, not generalizations
Use descriptive, non-judgmental language
Label subjective data as such
Focus on remediable behaviors, feasible solutions
Limit amount of feedback to three or fewer observations
Be aware of own subjective feelings and assumptions, and manage them appropriately
Listen, understand recipient’s perspective and feelings

15. Addressing Performance Issues

16. Addressing Performance Issues
Acknowledge awkwardness and discomfort
State performance Issue
Elicit and listen to individual’s self assessment
Acknowledgment or Dismissal of Problem

17. Addressing Performance Issues Acknowledgement of the Problem
Step 1
Define and analyze the problem together
Step 2
Problem solve together
Step 3
Make a plan to address with defined outcomes and timeline
Document feedback, plan and time to re-address

18. Addressing Performance Issues No Acknowledgement of the Problem
Step 1
Recognize/control your own emotional reaction
Step 2
Acknowledge individual’s emotions and perspective
Step 3
State your perspective, make a plan to address with defined outcomes and timeline
Document feedback, plan and time to re-address

19. Let’s Practice

20. P4 Student on APPE Rotation
You require students to obtain a complete medication history from patients as part of their fourth-year advanced pharmacy practice experience at your site. During the discussion of the patient, one of your students clearly only documented the medication names and did not evaluate the dose, timing, reason for use, patient adherence or patient understanding of the medications, which was a vital component of the instructions. You are upset because this student has neglected this information in the past, and you have told him or her to include it in the future. You abruptly end the conversation and tell the student to go figure out what is missing and return to you when they are ready to have an informed discussion.

21. P4 Student on APPE Rotation
Review student’s understanding of expectations to ensure clarity
Ask what elements the student/resident thinks should be included and why
Discuss elements preceptor thinks should be included and why
Reconcile the differences and reasons
Point out exact missing elements and discuss what should be different – problem solve
If possible, re-attempt and re-evaluate the exercise as soon as possible and reinforce positive behaviors
Document and compare periodically and at the end

22. PGY1 Resident on Rotation
You are a residency preceptor at your hospital. You ask the resident on your rotation to develop a plan for a new service you plan to start. The resident submits the plan to you, but it does not include the specific features that you asked for. You perceive this resident to be sensitive, and you do not want to sound unappreciative or critical. So you tell the resident, “Thank you for working on this. There are a few things missing, such as how patients can be referred to us, but it looks good.”

23. PGY1 Resident on Rotation
Review the specific elements you asked for and what has been presented
Encourage self-assessment
Determine which elements are missing and why
Problem solve to get the desired results
Assess understanding
Be open to comments
Review and Redo

24. Consider how you would evaluate…
Student/Resident that does “everything right”.
Student/Resident that “knows it all”.
Student/Resident that seems to need additional help or even remediation.
Residents and students on rotation at the same time.
Students on rotation at the same time.
Evaluating presentations and in-services.
Evaluating personal behaviors that are inappropriate.
Students/Residents with medical/mental complications.

25. Question All are tips for successful feedback sessions except:
Encourage participation and self-assessment
Provide vague examples of expectations
Reinforce desired behaviors
Acknowledge perspective and feelings

26. References
Accreditation Council for Pharmacy Education Standards accredit.org/deans/StandardsRevision.asp
American Society of Health-System Pharmacists Accreditation Standard PGY
Providing feedback to enhance pharmacy students’ performance. Am J Health Syst Pharm December 15, : ; doi: /ajhp070316
Chur-Hansen A, Koopowitz LF. Formative feedback in teaching undergraduate psychiatry. Acad Psychiatry. 2005; 29:66–8
Kern DE. Confronting Individuals About Performance Problems. Johns Hopkins Faculty Development Program for Clinician-Educators. (Supplement to Handout)
Eliciting Feedback. Johns Hopkins Faculty Development Program for Clinician-Educators. (Supplement to Handout)
Staying Alive in Principle Five: Ideas on Where to Begin;

27. Pharmacy Precepting Pearls of Practice Providing Criteria-Based Feedback
Lanita S. white, pharm.d.
Assistant professor, department of pharmacy practice
Director, 12th Street health and wellness center
University of arkansas for medical sciences

28. Questions? Kim Young, Pharm.D., BCPS Debbie Waggoner, Pharm.D., BCNP
Lanita White, pharm.D.