Feedback on the Fly
feedbackTransition day 2014
kcabdeeffeedbakfeedback1FeedbackA system by which some of the
energy from the output of a communications circuit is returned to
the input circuit, either to increase or reduce the power or to
regulate the quality of the signal.A sensory or perceptual report
of the result of any behavior which may reinforce or modify
subsequent behavior. Feedback is the control of a system by
reinserting into the system the results of its performance. If the
information which travels backwards from the performance is able to
change the general method and pattern of performance, we have a
process called learning. " Jack Ende3FeedbackOperant
conditioning?(Type II reflexes)What do these nice people have in
common?
Renee Flemimg Larry Bird; Abraham Verghese5All are elite, expert
performers
Renee Flemimg Larry Bird; Abraham Verghese6All are elite, expert
performerswho know that practice makes perfect
Renee Flemimg Larry Bird; Abraham Verghese7In theory there is no
difference between theory and practice... -Yogi Berra
8In practice, there is.
-Yogi Berra
9Expert,Elite PerformerNOVICEMiller GE. Academic Med.
1990.Cognitive10NOVICEMiller GE. Academic Med.
1990.SkillsExpert,Elite
Performer11AbilityExpert/MasterProficientCompetentAdvanced
BeginnerNoviceDreyfus SE,
1980ObserverReporterManagerInstructorInterpreterORIME 12The
acquisition of superior performance in medicineis closely related
to engagement in practice with feedback during medical
training.
-Ericcson, Academic Med 2004
13If you dont know where youre going, you might endup someplace
else.-Yogi Berra
Feedback can be your GPS14Patient care: Information
Management-recording & presentingData Gathered from History and
Physical ExamPresentations disorganized.Difficulty discerning
amountof detail needed. Imprecise, Assessments not well defended
Presentations fluent, wellorganized, clinically preciseAble to
discern relevantdetails while staying concise.You can learn a lot
by watching-Yogi Berra
Outside eyes and ears can help you learn a lot about yourself.
To see those blind spots.16Feedback: evaluation of performance
facilitates coaching
If Ive told you once Ive told you a thousand times! Its i before
e except after c!
Medical Math
Feedback = teaching
Feedback
SO WHAT PART OF MY INSTRUCTIONS DID YOU NOT UNDERSTAND?!?!?I
SAID THATS i BEFORE e EXCEPT AFTER cWhat would be effective
feedback for you?We dont all receive feedback in the same way.If
you have received feedback that was ineffective, why was it so?
If you received feedback that was effective, how was it
different?
For example,The case of Millie KablunschkiWas this feedback?A
sensory or perceptual report of the result of any behavior which
may reinforce or modify subsequent behavior.
Feedback occurs when a recipient gains insight into what they
did and is instructed in its consequences and ways to improve
Feedback in this case? The teacher said:1. Student did not focus on
the patient first2. Student did not give pertinent findings3.
Student was reminded that vitals are always pertinent4. Student was
re-taught that a CXR cannot make a diagnosis5. Student was informed
about consequencesWas it effective feedback?Thats up to the
receiver
Do we recognize feedback?We receive a lot of feedback every day
Learn to identify itLearn to act on itMost feedback is not received
in formal, sit-down settings It is not personalOur dress, behavior,
speech, habits all affect how we perform as a professionalTone of
voice, facial expression, email composition can sometimes
overshadow the message tune in to the messageEffective feedback
should be:1. Delivered face to face2. Delivered in appropriate
doses3. Delivered in a timely fashionIts all in the eyes
Effective feedback should be:1. Delivered face to face2.
Delivered in appropriate doses3. Delivered in a timely fashion
I must talk to you about your nose hair.
Effective feedback should also be:1. Specific, Concrete,
ObjectiveAsk for examples. Response? vital signs need to be in
every note.Facts are difficult to dispute, focus on work product,
i.e. patient care2. Professional Respectful in voice, words,
timing, locationWe are future colleagues3. Explanatory,
educationalBe sure to check the chart. As you learned from Mrs.
Kablunschki there is no need to order labs that have been done
recently.4. A plan for improvementFocus on the next step in
learning, improved performance, how to make our work/patient care
betterMake sure it is specificIf student Nonny hears: good jobNonny
will assume he is doing honors workIf Noddy hears: good jobNoddy
will assume she is barely keeping upFeedback given in a stressful
situation may require repetition (and medical school is
stressful)E.g. Remember yesterday I told you that vital signs are
always pertinent so I expect you to report them on every patient.
What to know about giving feedbackStudents also give feedbackIt
needs to be:objective, timely, professional, explanatory, and a
plan for improvementWe need to be able to trust the feedback we
receiveProvider must be observant, competent and objective to
provide the appropriate feedback Students must be the same
What to know about giving feedback
What to know about feedback1. Skill development (learning)
depends on getting practical and timely feedback based on direct
observation.2. We can influence quantity and quality of feedback we
get. Take initiative and be prepared to invest in the
beginningIdentify, set and share learning goalsCreate opportunities
for practice with observationSchedule times for feedback3. Pick up
on the positive, catch the message in any delivery4. Tune in and
respond to feedback givenYouve got to be very careful if you dont
know where you are going, because you might not get there.-Yogi
Berra
37Whats the point?Keep the goal in mind better patient
careBecause it isnt about me,It is about how best to serve my
patients
Excuse me for interrupting, but its i before e except after
c.
(Weird isnt it?)
The ends
