1. Effective Feedback
Fiona Spencer

2. What is feedback?
‘information given to a trainee with the intention to improve their performance’

3. When do we give feedback?

4. When do we give feedback?
When a trainee undertakes a WpBA?
When completing a CS report?
When completing an ES report?
When a trainee makes a mistake?
When a trainee undertakes a procedure?
When a trainee does something well?
After an examination?

5. When do we give feedback?
All the time!

6. Why do we give feedback? Johari’s Window Known to self Unknown to self
Known to others
OPEN
BLIND SPOT
Unknown to others
FAÇADE
CLOSED
Johari’s Window

7. Why do we give feedback? Strengths Areas for development Appraisee 1 3
Appraiser 2 4
Reinforcing good practice encourages it and is motivating
Corrective feedback enables trainee to recognise consequences of their actions and encourages them to modify their actions to get a more desirable result

8. A Simple Model of Competence
Does
Shows how
Knows how
Here are the levels of competence; the next slide is how to determine where trainees are
Knows

9. HIERARCHY OF KNOWLEDGE –
determining the learner’s knowledge
Open Question
How well have you managed this patient?
What have you learnt?
Evaluation
In this patient, what is the diagnosis?
Is there a treatment plan?...likely outcome?
Analysis
Synthesis
What do these findings mean?
A more detailed exposition. How aware are CSs of this progression?
What are the causes?...effects?
What do you understand by…?
Comprehension
Facts
What, when, where?

10. Adults learn best when:
When clear objectives are set
And they help set them
The learning is purposeful and structured
Relevant to their needs
They are actively involved
A variety of learning methods are used
Builds on their previous experience
When feedback is given
They engage in reflection 10

11. Few trainees perceive they receive regular effective feedback Sometimes we don’t give good feedback

12. Feedback boxes on WpBAs
“Read more around subject” “Do more” “More practice” “Do harder cases” “No problems” “Competent”

13. So what makes it effective/good feedback?

14. Effective Feedback
In order to be effective it must be given and received appropriately
Given immediately if possible so fresh in mind
Builds on strengths and needs
Describes behaviour and impact
Specific and Sensitive
Involves the appraisee
Confronts important or difficult issues
Gives guidance on rectifying behaviour
Is understood and accepted by the appraisee
Is from a respected source

15. Why go over what went well?
Use a positive critique
‘Well done – I really liked the way you did ….’ This re-enforces good practice and encourages trainees to retain and build on the good aspects and not misinterpret this area
Increases trainee motivation and completes the learning cycle of reflection, action planning and future repeat (improved) performance

16. Giving feedback when not so good!
Trainees try to jump to this often but do positives first
Retain the positive theme by feeding back what they can do to improve, rather than what they are not good at
‘In order to make that even more effective….’
Focus on 1 or 2 important areas for development at a time

17. Feedback – Pendleton’s rules
Clarify any points of information/fact;
Ask the learner what s/he did well – ensure that they identify the strengths of the performance and do not stray into weaknesses;
Discuss what went well, adding your own observations, re-enforce positives, keep to the strengths.
Ask the learner to say what went less well and what they would do differently next time.
Discuss what went less well, re-enforce what you agree with adding your own observations and recommendations of something you would like them to do differently
Agree an action plan- get commitment from trainee and make sure they understood the points made

18. Effective Feedback
In order to be effective it must be given and received appropriately
Given immediately if possible so fresh in mind
Builds on strengths and needs
Describes behaviour and impact
Specific and Sensitive
Involves the appraisee
Confronts important or difficult issues
Is understood and accepted by the appraisee

19. Is this a bit artificial?
It can be with senior trainees so can use alternative approach
Start with “Can I make a suggestion….”
Give 2 reasons why you think it is a good idea: one suggesting what it would achieve and something it would prevent or solve
Make an overall positive statement about the learner or their abilities
“With your expertise at X this would be likely to give an excellent outcome…”

20. Feedback sandwich
If you want to make a development point eg about a step in procedure or in a busy clinic
Say something positive
Make development point
How many positive points do we need to hear to cope with a negative one?

21. Informal vs Formal Feedback
Day to day in context of work activities
Frequent
Discuss skills or specific behaviours in small doses
Consider separate planned formal feedback sessions
Prepare by collecting info from other sources too
If we give frequent informal feedback then trainees would not complain about lack of feedback
Problems would be identified early
Stage set for progress
No surprises at formal feedback sessions

22. Practice giving feedback
Notes re scenarios and role play
In 3s
Trainee
Trainer
Peer observer

23. Examples of good feedback?

24. Make WpBAs more valuable
Make sure you record the feedback given
Timely fashion
Make sure trainee reflection is included
Pendleton’s rules
Be focussed, specific objectives
SMART
Ask trainee to repeat the task working on those areas to show development
Agreed action plan

25. What else to give feedback on?
Think about other useful areas
Communication skills/attitudes to staff or patients
Consent
Documentation
Running a list of procedures
Coping with case load
Time management
Supervising a junior trainee
Quality improvement ideas/projects
Organising teaching
Chairing a meeting

26. Summary When to give feedback – All the time
Why we give feedback – Encourages learning
How not to give feedback
What is effective feedback
Ways to give feedback -Pendleton’s rules
Practiced feedback