The purpose of this course is to improve feedback, clinical teaching, and assessment of clinical skills.
01.09 - Wrap-up - Video Discussion
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Teaching and Assessing Clinical Skills
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UNIT 1 - PROVIDING FEEDBACK
The objectives for this module are that after you actively engage in the activities, you will be able to 1: Understand the importance of feedback and the barriers to providing feedback. 2: Provide effective feedback to learners.
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Sally Santen, M.D., Ph.D.Associate Professor - Emergency Medicine
University of Michigan Medical School
Welcome back.
We are now going to cover some of the major concepts,
concepts that we saw in the, in the videos and
that Jocelyn and I discussed to review the important points of feedback.
The first one is that it needs to be timely.
We need to make sure that we provide feedback in approximate time to
the performance that was provided.
If you tell them a week later or
a month later, they're not going to remember what they were doing.
And so make sure that the feedback that you're providing is timely.
The next thing is that it needs to be based on personal observation.
It is not your role to say everyone in the department thoughts that,
thought that you were bad at procedures.
It, that's not your role.
It's the role of the supervisor or the residency director,
whoever is responsible for the final evaluation of that learner.
And so the, the feedback that we need to provide should be
based on personal observation and should probably start with, I saw or I noticed or
something in that personal sense.
That says that it was based on personal observation.
The next thing is that needs to be clearly labelled as feedback.
That's part of the disconnect between residents thinking that they're feed,
getting feedback or
not thinking they're getting feedback and faculty providing feedback, so make sure
that you clearly label the feedback as feedback in the sessions that you provide.
The next thing is that it needs to be descriptive.
It should be, using labels.
That are relatively non judgemental.
That are descriptive in the process that they're doing.
And so communication might be empathetic.
It might be insightful.
It might be, Directed, but those, these are the things that you want to be
using in the, in the feedback that you are providing.
The next thing is that it needs to be constructive.
It's important not to destroy the ego or the psyche of the learner so
that they can't learn and they can't listen, and
it needs to be constructive to build an improvement in performance.
The next thing is it needs to be specific, something of.
That was the worst performance that I've ever seen is both judgmental in
general and will not help them improve.
However, if you say specifically I notice that your gloves were too large, or
that the sterile field was not kept because you did this with your catheter,
then they will actually be able to do something to improve.
We tend to say, nice job, poor job.
But in gross generalities, not specific enough for
the learner to be able to improve.
So be very intentional about making sure that the information that
you're providing is specific enough to be able to act on.
The next thing is it needs to be non-judgemental.
If you're getting a lot of judgement,
like Judge Judy, then they're not going to be likely to listen.
They're going to close down and not think about what you're saying, but
just think about the defence of what the performance they did is.
It is better to simply do observational, that ie, the sterile field was not.
Kept rather than you are a bad finish, physician because you can't keep the seril
field, so try to be non-judgmental in the feedback that you're providing.
The next thing is it needs to be balanced.
In a few minutes we'll talk about the feedback sandwich, both good and bad.
But what I men here is that it should be balanced between what is done well and
what is done.
Poorly or in fact needs to be improved.
So, balance, what you put in the content with what's good and
what's bad so that the learner has a sense of things that they need to
keep doing along the same lines and things that they need to improve upon.
So make sure that it is balance.
The next thing is that it needs to be directed.
Like I said about.
The the sterile field.
If you simply are, give a gross judgement of the sterile field was not kept, but
don't give specific examples, then the learner doesn't really know how to,
how to improve.
So make sure that you're directing the feedback to something that can
be improved.
This little dog eats poop and then she likes to kiss people.
Now, I'm not sure that I can actually change that behavior.
Behavior and that I can provide her feedback that will change it.
But think about the things that you an actually change in the behavior that
the people do.
Like the feedback directed at what they're able to
change verses what they're not able to change.
The next thing is, we're going to show you a video in a little bit that has so
many things wrong with it that you're going to provide feedback on
absolutely everything between the sterile field and the mean.
Communication with the patient.
You want to provide feedback on all of these things, because the learner does
such a such a job on this spinal tap, but you really need to be selective.
People can only remember a couple of things at a time, three to five at most,
and so it's important just to focus on a few key topics, and
not to try to cover everything.
Whatsoever that was done poorly.
So choose your ideas and
then focus on those in the times that you provide feedback.
And it it important to focus.
So you need to be directed and focused on those items.
The final thing is that you should probably have it tempered to the,
you should temper your feedback to the learner's temperament.
If they know that they've done something wrong or that there is a problem,
then being somewhat supportive is probably a good idea.
If they have no idea that they've done something wrong,
then it may be that you have to really direct them to understand that.
And so that's really important in terms of the feedback that we provide.
One of the thing, the things that we talk about for feedback is whether or
not feedback is positive or negative.
What we've discovered and even what the researchers have discovered in
feedback is it's not whether or not feedback is positive or negative.
But it is instead what is, whether or not the feedback is confirming or
disconfirming to the learners' sense of themselves.
If you tell a learner something that is confirming to their understanding, but
is in fact negative feedback, the learner already understands that
it's a problem and will move forward and do something about it.
However if you give disconfirming feedback.
So feedback that is against what their view of theirself or their performance is.
Then the feedback really needs to be focused on getting them
to understand that this is the situation.
Let me give you an example.
If a student does poorly on a test,
they probably know that they've done poorly on that test.
And the feedback that you're going to give,
although it is negative feedback, i.e.,
they did a poor job, it, in fact, is confirming to
the learner's self assessment, and they will be able to understand that feedback,
take that feedback, and move forward with an action plan.
Because the feedback confirms their sense of their, themselves.
On the other hand,
let's say you have a resident who thinks that that she's a great communicator.
But you watch her snip at the nurses or be short with their, with her patients.
The feedback that you're going to provide to her is dis-confirming.
She thinks that she's a good communicator.
However, you think that she's a, a poor communicator and so the feedback that
you're providing to that learner is dis-confirming to her sense of self.
And so the important thing there is that you're going to have to get that learner
to understand that what she's doing is actually not what she thinks she's doing.
That she's, that she is snippy with the nurses,
that she is short with her patients.
You've gotta get that disconfirming feedback to become confirming to her own
sense of self.
So the feedback really needs to be moderated to the learner's temperament.
It should also be a two way purpose, because we talked earlier.
It's not top down, it's not hierarchical,
it's not me providing the absolute judgment of what somebody's doing.
It should be a two way process that informs both
the person giving feedback and
the person receiving feedback so they are on the same page, and so that in the end.
The feedback that's provided in the action plan going is confirming so
that they can move forward.
The final thing is that feedback needs to address actions.
It needs to be based on things that learners are doing or performing or
in actions that they're doing, rather than attitudes or
things that they cannot change.
If a learner has a bad attitude, it's much harder to change that attitude, but
you can ask them to change their actions and behaviors around that attitude.
For example, if a resident is, is, angry,
or, pressured, it's not that you're going to change their anger necessarily,
but you want that not to be seen.
You want their behaviors not to reflect that anger.
If they're extremely busy or stressed, I can't change the stress level.
Although, I, I may be able to help someone, but
I want their behavior to show that they're not necessarily stressed.
So, address things that are actions that people can change.
And then with the hope that it will improve performance.
All right, we're going to move on to the next segment.
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