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Medicine,Dentistry andVeterinary Medicine

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Medicine,Dentistry andVeterinary Medicine

Giving feedback

Tools of the Trade21st November

University of Leicester

Dr Adrian Hastings and Dr Rhona Knight

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What is in the handout?

• Why bother with feedback?• What is feedback?• Key features of feedback• General principles of feedback

– Types– Guidelines

• A feedback toolbox• Useful pre and post course reading

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Why bother with feedback?

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Why bother?

• ‘Feedback, or knowledge of results, is the lifeblood of learning.’

• Rowntree D (1982) Educational Technology in Curriculum

Development (2e). Paul Chapman Publishing, London. • ‘Feedback is an essential component of education

and adult learning.’• Branch WT, Paranjape A. Feedback and reflection: teaching

methods for clinical settings. Acad Med. 2002:77, 1185-8.

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Why bother?

• It works:– improves learning outcomes

– better marks in assessments– better results in other learning situations

– deepens approach to learning– encourages active pursuit of understanding and application

of knowledge

• Black P and William D (1998) Assessment and classroom teaching. Assessment in education 5:7-73.

• Rolfe I and McPherson J (1995) Formative assessment: How am I doing? Lancet 385:837-9.

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What is it?

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What is it?

• ‘A two-way process in which an educational supervisor or group appropriately share with the learner information based on observation, with the aim of reaching a defined goal.’

• Knight R. The Good Consultation Guide for Nurses, Radcliffe 2006.

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Key features of feedback

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Key features?

Challenge

Support

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General principles of feedback

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Types of feedback

• Brief feedback• Formal feedback• Major feedback

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TEAM Guidelines

• Timing

• Environment

• Appropriate

• Manageable

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A feedback toolbox

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A selection of tools

• Tool 1: Pendleton’s ‘Rules’• Tool 2: Calgary - Cambridge• Tool 3: Non-judgemental feedback• Tool 4: Observation versus deduction• Tool 5: Pi• Tool 6: PEE• Tool 7: Unacceptable behaviour

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1. Pendelton’s ‘rules’

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1. Pendleton’s ‘Rules’(Pendleton D, Schofield T, Tate P, Havelock P. The New Consultation. Oxford University, 2004.)

• The learner goes first and performs the activity

• Questions then allowed only on points of clarification of fact

• The learner then says what they thought was done well

• The teacher then says what they thought was done well

• The learner then says what was not done so well, and could be improved upon

• The teacher then says what was not done so well and suggests ways for improvements, with discussion in a helpful and constructive manner

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2. ‘Calgary – Cambridge’

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SET-GO (Silverman et al.)

• What I Saw

• What Else did you see?

• What does the learner Think?

• What Goal are we trying to achieve?

• Any Offers on how we should get there?

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ALOBA(Silverman et al.)

• Agenda

• Led

• Outcome

• Based

• Analysis

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3. Non-judgemental feedback

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Non-judgemental feedback

• Based on description

• ‘Communication skills are neither intrinsically good nor bad, they are just helpful, or not helpful, in achieving a particular objective in a given situation’

– Silverman et al

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What is it?

• Evaluative/judgemental

– The beginning was awful, you just seemed to ignore her.

– The beginning was excellent - great stuff!!

• Descriptive

– At the beginning you were looking at the notes, which prevented eye contact.

– At the beginning you gave her your full attention and never lost eye contact – your facial expression registered your interest in what she was saying.

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4. Observation vs deduction

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Observation versus deduction

• Separate behaviour and interpretation• Make interpretations tentative

• I noticed at this stage that you moved more in your seat, and your face became red, I wondered if you might be embarrassed?

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5. Pi () – Point / Illustration

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Pi () – Point / Illustration

• Make sure that the student knows what you’re talking about!

• As well as a label, give an example

Point

Illustration

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6. PEE – point / explanation / example

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PEE – point / explanation / example

• Make sure that the student knows what you’re talking about!

• As well as a label, give a reason and an example

Point

Explanation

Example

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7. Unacceptable behaviour

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7. Unacceptable behaviour(West Midlands modular trainers’ course, 2003)

• 1. Check person is OK before you start• 2. Use a wake-up, warning phrase:

“There’s something very serious I have to say”

• 3. Say, very simply, what is not right• 4. Give an example as appropriate• 5. Relax the tone to allow for a positive response

• usually an offer to improve ensues• 6. Respond to offer positively

• but define specific, measurable outcomes• 7. Do not be drawn into discussion on

– justification of behaviour – your right to judge

• 8. Most of us take criticism better if it is not personal.– “Maybe what I did was not good – but it doesn’t mean I’m no good.”– Make sure that the student can see this distinction too

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Summary

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Good feedback is

• Suited to purpose• Specific• Directed towards behaviour rather than

personality• Checked with the recipient• Problem solving• A suggestion rather than prescriptive

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TEAM Guidelines

• Timing

• Environment

• Appropriate

• Manageable

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Useful further reading:• Teaching made easy

• Chambers and Wall• Radcliffe 2000• ISBN: 1-85775-373-9

• Teaching and learning communication skills in medicine• Kurtz, Silverman and Draper• Radcliffe 1998• ISBN: 1-85775-272-2

• Adult and continuing education• Jarvis• Routledge 1995• ISBN: 0-415-10242-1

• The Good Consultation Guide for Nurses • Hastings and Redsell (eds)• Radcliffe 2006• ISBN: 1-85775-688-6

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Useful pre-course reading

• Ende J. Feedback in clinical medical education. JAMA. 1983:250,777-81– http://www.utmb.edu/surgery/clerks/feedback.htm

• Silverman J, Draper J, Kurtz SM. The Calgary – Cambridge approach to communications skills teaching 1: Agenda led outcome based analysis of the consultation. Educ Gen Prac.1996; 7, 288-99

• Silverman J, Draper J, Kurtz SM. The Calgary –Cambridge approach to communications skills teaching 2: SET-GO method of descriptive feedback. Educ Gen Prac.1996; 8, 16-23

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