1. ©2003 Community Faculty Development Center Teaching Culture and Community in Primary Care: Giving Feedback

2. ©2003 Community Faculty Development Center Workshop Objectives  Use the plus/delta technique to critically observe a learner’s communication skills  Provide effective feedback to an individual learner about a cross-cultural clinical encounter By the end of the workshop, participants will be able to:

3. ©2003 Community Faculty Development Center Workshop Outline Feedback revisited Implications on culture Plus/delta revisited Small group practice

4. ©2003 Community Faculty Development Center Feedback Revisited GOAL OF FEEDBACK: Ensure that the learner improves, while at the same time maintains self- respect

5. ©2003 Community Faculty Development Center Maintaining self-respect Helps learners “move up the ladder” Prevents egocentric, defensive postures Model empathic styles CULTURALLY EGOCENTRIC CULTURALLY SENSITIVE MINIMIZATION

6. ©2003 Community Faculty Development Center Characteristics of Good Feedback Encourage self- assessment Covers positives and negatives Refers to specific, observed behavior Timely and limited in amount Occurs in appropriate place Ends in an action plan

7. ©2003 Community Faculty Development Center Characteristics feedback in context of cultural learning objective Encourage self-assessment –Facilitates self-reflection –Promotes self-awareness Refer to specific, observed behaviors –No presumption of attitude –Provides opportunity for change and growth

8. ©2003 Community Faculty Development Center Match teaching styles to needs and objectives “That guy’s so ignorant. I’m not going to waste my time on patient education.” “John, you’re such a sexist pig. Get your act together!” “Why should I be nice when she swore at me?” “I can’t believe that I said that. I’m so humiliated.” Assertive: “When you say that he’s ignorant, I’m offended. This is someone I care about. Facilitative: “Jill, it sounds as though you are upset because John made that remark.” Suggestive: “You might want to think about the power difference here.” Collaborative: “Let’s think together how we can learn from this.

9. ©2003 Community Faculty Development Center Plus/Delta ObservationPlusDelta Listen actively? Without interuption? Elicit patient’s perspective, health beliefs and practices? Assess priorities, values, supports? Recommend treatment simply and understandably? Negotiate plan by involving patient?

10. ©2003 Community Faculty Development Center Case Vignette Setting: Primary Care Office E Rivera is a seven-year-old male coming in to see you following an emergency room visit for shortness of breath attributed to asthma. You have followed him for several years, and have repeatedly reviewed the standard of asthma care with his mother according to the published practice guidelines. You are concerned that she is non- compliant with anti-inflammatory medicines. Recently, one of your attendings spoke about the impact of folk beliefs on asthma management in Puerto Rican families, and you want to explore the idea that E’s mother is non- compliant because of folk beliefs.

11. ©2003 Community Faculty Development Center Case Vignette STUDENT TASKS: 1. Explore chief concerns and present illness, including patient's perspective of illness and management of his problems. 2. Negotiate a treatment plan together.

12. ©2003 Community Faculty Development Center Practice Case: Observe for the following: The rapport between patient and student The content of the student’s communication The student’s reactions to the information presented by the patient.

13. ©2003 Community Faculty Development Center Your Charge! Create a composite plus/delta sheet in the small groups Practice giving feedback Deliver feedback on feedback

14. ©2003 Community Faculty Development Center Video Sequence* - LEARN L isten.wmv L isten.wmv E licit.wmv E licit.wmv A ssess.wmv A ssess.wmv R ecommend.wmv R ecommend.wmv N egotiate.wmv N egotiate.wmv * To play, either open hyperlink or click text when viewed from Slide Show