feedback-workshop-presentation-april-8-intapt.ppt

bccgcbgcbc

1. I N T A P T
A P R I L 8, 2 0 11
GIVING EFFECTIVE FEEDBACK:
A TEACHER’S TOOLKIT

2. FACILITATORS
•Glenda Bendiak
•Annie Cloutier
•Kathleen Doukas
•Paula Shing
•Donna Spaner
2

3. FORMING, STORMING, NORMING,
PERFORMING!
3

4. HOW DID I GET HERE?
How did YOU come to be here, on
this day, in this workshop, as this
person?
4

5. RESULTS OF NEEDS ASSESSMENT
•Short needs assessment conducted October 24, 2010
after workshop outline presentation
•Purpose: guide our group in developing a workshop that
met needs of other learners
•7 people completed needs assessment
•Response rate = 70%
5

6. RESULTS OF NEEDS ASSESSMENT
•Question 1. How important is feedback in teaching
situations?
•All respondents indicated feedback was either importantor very
important
•Question 2. How comfortable are you giving
feedback to learners?
•All respondents were either very uncomfortable or somewhat
uncomfortable giving feedback
6

7. RESULTS OF NEEDS ASSESSMENT
•Question 3 –“What would you like to learn about
giving feedback?”
How to give negative feedback/difficult learners(3)
Strategies for providing constructive feedback(1)
How to give meaningful, concise and useful feedback(3)
7

8. RESULTS OF NEEDS ASSESSMENT
•Question 4 -“What are the biggest barriers you face
in giving feedback?”
The problem learner/resistant learner(4)
Lack of time(2)
Concern about upsetting the learner(1)
8

9. LEARNING OBJECTIVES
•To describequalities of effective feedback
•To appreciatecommon barriers to giving feedback and
giving feedback in difficult situations
•To incorporatea feedback model in the form of a toolkit
framework with concise and meaningful take home
messages
•To developan increased comfort level with giving
feedback
•To demonstrateincreased ability to integrate newly
used feedback skills through role play
9

10. THE TOOLKIT
10

11. What is Feedback?
11

12. FEEDBACK: THE NEED FOR A
DEFINITION
•Although feedback is viewed as important, there is little
consensus on its definition
•The agreement on the meaning of feedback between the
instructor and student is not always evident
•Instructors frequently believe they are giving feedback,
whereas trainees report feedback is rare
•Research on effective feedback cannot be performed without
a clear operational definition of feedback
Van de RidderJMM, StokkingKM, McGaghieWC, ten Cate OTJ. What is
feedback in clinical education? Med.Educ. 2008 February;42(2):189-197
12

13. PROPOSED DEFINITION
•Feedback is:
•“Specific information about the comparison between
a trainee’s observed performance and a standard,
given with the intent to improve the trainee’s
performance.”
Van de Ridderet al
13

14. Why do youthink feedback is important?
14

15. FEEDBACK –WHY IS IT IMPORTANT?
•Studies confirm that the human learning process at all
levels can be substantially enhanced with knowledge of
progress and specific directions for improvement
•Without such feedback, learning is slow, difficult and sometimes
virtually impossible
Astin,1993
15

16. FEEDBACK: WHY IS IT IMPORTANT?
•Helps learner achieve their learning goals
•enforces engagement with learner’s training
•Without feedback, mistakes can go uncorrected and bad
habits can develop
•the learner may also drop positive behaviours or make inaccurate
assumptions
Piccinin, Crisiti& McCoy, 1999
16

17. FEEDBACK: WHY IS IT IMPORTANT?
•Needed for the development of competency and expertise
•Clinicalreasoning
•Criticalthinking
•Judgment
•Facilitates learning process and teaching performance
•Improves teaching skills
•University teachers receiving feedback aimed at improving teaching
showed improvement immediately post consultation and this
continued to be observable 3 y later
Piccinin, Crisiti& McCoy, 1999
Côté et Bélanger, 2006
17

18. THE EVIDENCE FOR FEEDBACK
•1912 –Thorndike’s study
•providing simple feedback about line length allowed students to
draw lines of specified length faster vs. those who received no
feedback
•OSCE (1992)
•Students who performed OSCE with 2min of feedback
significantly improved performance on identical stations vs.
controls
•Improvement is maintained up to 3 molater
Shannon & Norman, 1995
18

19. THE EVIDENCE FOR FEEDBACK
•Feedback in medical interviewing skills (1986)
•Improved interviewing performance immediately and 5y later vscontrols
•Feedback delivered in the sandwich manner (positive-negative-
positive) is rated most desirable, acceptable and accurate by
students
•Feedback from a group leader or preceptor is valued more than
feedback from peers or patients
•Feedback including objective evidence of performance may be more
effective than specific comments from an observer
Shannon& Norman, 1995
19

20. Setting the Tone
20

21. HOW TO PREPARE TO GIVE FEEDBACK:
SETTING THE TONE
•Create a positive relationship, a climate of trust and
safety (non-threatening)
•Choose appropriate physical location/ environment as
able
•Collect descriptive data while observing actual
performance (write it down!)
•You should target specific performance and changeable
behaviours
21

22. QUESTIONS TO ASK YOURSELF…
•What was performed well and what could be performed differently?
•What specific behavioursdo I want to comment on?
•Can this behaviourbe modified and if so, what behaviourwould I like to see in
its place?
•What is the priority for improvement?
•How can I express respect and support for the learner as I provide feedback?
•Is it the right time and place?
Dent & Harden, 2009
Mckinley, Williams & Stephenson, 2010
22

23. •“Students will forget what you said and they will
forget what you did BUTthey will never forget how
you made them feel”.
Piccinin, 2003
23

24. WATCH, CONSIDER, DISCUSS!
What do you think of the feedback given
in the following video clips?
24

25. 25

26. Principles & Qualities of Effective Feedback
26

27. PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
•Feedback is effective if it:
•promotes learning
•increases motivation
•enhances self esteem
•leads to deepening of relationship between the giver
and receiver
Piccinin, 2003
27

28. PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
•Solicited
•a person requesting feedback is more likely to accept feedback
and respond to it
•Attentive, caring and respectful in delivery
•more fruitful to emphasize positive consequence of their amended
performance than to use threats
•Collaborative
•reduces power distance in the relationship, more egalitarian, less
threatening, more encouraging
Côté et Bélanger, 2006
28

29. PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
•Well-timed
•as soon as possible after the event keeping it concrete and
relatively free of distortion from lapse of time
•Expected
•Clear and Direct / Specific
•focus specifically on behaviour, not general performance
•give feedback on decisions and actions, not on an
interpretation of the student’s motive or personality traits
•Rounded or balanced
•giving positive and negative
•Use descriptive terms
•Provides direction for improvement
Côté et Bélanger, 2006
29

30. PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
•When feedback is subjective, label it as such
•Using“I”statements expresses feedback in terms of personal
opinions, feelings and your assessment of the situation
•Using evaluative statements beginning with“you” tends to sound
accusatory
•Make Eye contact
•Control emotions, try to keep cool
•Try not to overload the learner, be selective and limit to 1 or 2
items only
•Too much constructive or negative feedback can demoralize the
learner
Côté et Bélanger, 2006
30

31. PRINCIPLES & QUALITIES OF EFFECTIVE
FEEDBACK
•Encourage reflection; ask for self-assessment
•this can create insight into their behaviour, move the discussion to a
more complex level and form a basis for improvement
•Label clearly as feedback
•Check for understanding
•Askfor a summary of what the student has retained
•Propose pedagogic follow-up
Côté et Bélanger, 2006
31

32. SUMMARY: EFFECTIVE FEEDBACK
•Relevant
•Factual and Descriptive
•Timely, Frequent and Expected
•Specific and Focused on behaviour/performance
•Targetan alterable behaviour; must be able to “prove”
•Helpful with direction for improvement
•Balanced
•Collaborative
Dent & Harden, 2009
32

33. Types of Feedback
33

34. TYPES OF FEEDBACK
•Verbal
•Non-verbal
•we continuously send and receive non verbal messages
•via tone of voice, raised eyebrow, smile, frown, hand gesture or
body movement simultaneously
34

35. TYPES OF FEEDBACK
•Formative Feedback
•Interactive activity between teacher and learner
•Purpose is to improve or modify the learner’s knowledge, skills or
attitudes
•useful in promoting learning
•should be provided on a frequent basis to a learner for most effect
Bienstock, Katz, Cox et. al., 2007
35

36. TYPES OF FEEDBACK
•Summative Feedback
•Judgment is made about the learner’s performance for the
purpose of assigning grades, assessing competence, or
comparing performance to standards
•Thought of as a type of final assessment
•Not as likely to change learner’s behavior
Bienstock, Katz, Cox et. al., 2007
36

37. TYPES OF FEEDBACK
•Brief Feedback
•given often and is short, focused on a skill
•Formal Feedback
•provided when one sets aside time for feedback for 5-20 minutes-
may be feedback about a case presentation
•Major Feedback
•scheduled feedback lasting 15-30 minutes often to address major
issues or midpoint review
Branch & Paranjape, 2002
37

38. Models of Feedback
38

39. THE SANDWICH TECHNIQUE
•Reinforcing Statement: positive remark or
observation to learner
•Constructive Comment: constructive
observations ,
examples that need
change
•Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant , 2008
39

40. THE SANDWICH TECHNIQUE
Google images
40

41. A REAL-LIFE EXAMPLE
•Mr. X is a 73 year old man with metastatic lung cancer. He is on a
Palliative Care Unit and his condition is deteriorating. A family
meeting is held to clarify advance directives, as well as discuss the
extent of illness and prognosis with patient and his family.
•The Learner chairs the family conference while the teacher
observes.
•The Learner and teacher meet after the conference to discuss how
things went.
41

42. Role Play!
42

43. THE SANDWICH TECHNIQUE
•Reinforcing Statement: positive remark or
observation to learner
•Constructive Comment: constructive
observations ,
examples that need
change
•Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant, 2008
43

44. SANDWICH MODEL -STRENGTHS
•Good way of giving specific feedback to support learning
in a way that promotes respect, understanding and
corrective action
•Can be done quickly
44

45. SANDWICH MODEL -CHALLENGES
•Praise may obscure the corrective comment or serve no
function
•Learner may get tuned in to the “praise -criticism-praise
pattern” and come to be expecting criticism
•Subsequently, student learns to discount the praise
•Mostly a one-way transmission of information from the
teacher to the learner
45

46. THE PENDLETON MODEL
•Structured approach for talking about a learner’s
performance after an educational encounter
•such as a case presentation, consultation or a practical skill
•Pendleton’s rules build on the Feedback Sandwich to
promote a two-way process
•allows the learner to make observations about his or her own
performance.
Cantillon & Sargeant, 2008
46

47. PENDLETON’S RULES
•Briefly clarify matters of fact
•Learner states what was good about his/her performance
•Teacher states areas of agreement and elaborates on good
performance
•Learner then states what was poor or could have been improved
•Teacher then states what he or she thinks could have been
improved
Cantillon&Sargeant, 2008
47

48. A REAL-LIFE EXAMPLE
•Mr. X is a 73 year old man with metastatic lung cancer.
He is on a Palliative Care Unit and his condition is
deteriorating. A family meeting is held to clarify advance
directives, as well as discuss the extent of illness and
prognosis with patient and his family.
•The Learner chairs the family conference while the
teacher observes.
•The Learner and teacher meet after the conference to
discuss how things went.
48

49. Role Play!
49

50. PENDLETON’S RULES
•Briefly clarify matters of fact
•Learner states what was good about his/her performance
•Teacher states areas of agreement and elaborates on good
performance
•Learner then states what was poor or could have been improved
•Teacher then states what he or she thinks could have been
improved
Cantillon&Sargeant, 2008
50

51. PENDLETON’S RULES -STRENGTHS
•Like the Sandwich model, a good way to give specific
feedback in a supportive manner
•Easy to use
•Integrates the learner’s own self assessment and allows
for two way dialogue
Kurtz, Silverman & Draper, 1998
51

52. PENDLETON’S RULES -CHALLENGES
•Rules impose a strict order of feedback with good points having be
made before difficulties are discussed and the learner having to
make comments before the teacher
•Evaluative phrasing of feedback
•Learner’s agenda may not be discovered till late in the feedback
process when he/she will have an opportunity to mention areas of
concern
•May be an inefficient use of time
Kurtz, Silverman & Draper, 1998
52

53. REFLECTIVE FEEDBACK
CONVERSATION
•A modified interactive feedback approach which builds on the
Pendleton model
•Emphasizes learner’s ability to recognize his or her own
performance deficits
•includes a discussion about how the learner plans to improve
•Encourages development of reflective practice
Cantillon& Sargeant, 2008
53

54. REFLECTIVE FEEDBACK
CONVERSATION
•Teacher asks learner to share any concerns about a recently
completed performance
•Learner describes what they would have liked to have done better
•Teacher provides views on performance and offers support
•Teacher asks learner to reflect on what might improve situation
•Student responds
•Teacher elaborates on response, correcting if necessary
•Feedback ends with a clear and agreed plan for change
Cantillon& Sargeant, 2008
54

55. A REAL-LIFE EXAMPLE
•Mr. X is a 73 year old man with metastatic lung cancer.
He is on a Palliative Care Unit and his condition is
deteriorating. A family meeting is held to clarify advance
directives, as well as discuss the extent of illness and
prognosis with patient and his family.
•The Learner chairs the family conference while the
teacher observes.
•The Learner and teacher meet after the conference to
discuss how things went.
55

56. Role Play!
56

57. REFLECTIVE FEEDBACK
CONVERSATION
•Teacher asks learner to share any concerns about a recently
completed performance
•Learner describes what they would have liked to have done better
•Teacher provides views on performance and offers support
•Teacher asks learner to reflect on what might improve situation
•Student responds
•Teacher elaborates on response, correcting if necessary
•Feedback ends with a clear and agreed plan for change
Cantillon& Sargeant, 2008
57

58. REFLECTIVE FEEDBACK
CONVERSATION -STRENGTHS
•Collaborative approach: interactive and engages the learner
•Encourages self-reflection with emphasis on learner’s ability to
recognize performance deficits
•Discussion flow is natural with the goal of assisting the learner in
achieving their own critical analysis
•Motivates subsequent improvement in performance
•With practice, this model can be routinely incorporated into clinical
teaching and learning
Cantillon& Sargeant, 2008
58

59. REFLECTIVE CONVERSATION MODEL -
CHALLENGES
•May be time consuming, especially initially
•May be more effective immediately after the event which
is not always possible
•May be difficult for students with poor insight
Cantillon&
Sargeant, 2008
59

60. SIX STEP FEEDBACK MODEL
•Based on elements necessary to improve clinical
performance:
•An observed event (learner behavior)
•An appraisal of that event( teacher’s assessment)
•A recommendation for improvement
Brown, Hodges & Wakefield, 1995

61. SIX STEP FEEDBACK MODEL
•The impact of Feedback is increased when the
learner compares his/her self assessment with
feedback provided about his or her performance
Brown, Hodges & Wakefield, 1995

62. SIX STEP FEEDBACK MODEL
•Observe student behaviour/work
•Invite the learner’s self assessment of a clinical encounter
•Describe the desired behaviour
•Focus on 2-3 points
•Balance between positive and negative
•Relate back to original objective
Brown, Hodges & Wakefield, 1995
Hodges, 2003

63. SIX STEP FEEDBACK MODEL
•Make sure the student understands the difference
between current behaviour& desired behaviour
•Ask learner to paraphrase
•Elaborate a plan to close the gap
•Elicit ideas from learner to increase motivation
•Share information rather than giving advice
•Follow-up on improvement
•Ensure that recommendations for improvement are carried out
•Assess that performance has improved and give feedback
Brown, Hodges & Wakefield, 1995
Hodges, 2003

64. A REAL-LIFE EXAMPLE
•Mr. X is a 73 year old man with metastatic lung cancer.
He is on a Palliative Care Unit and his condition is
deteriorating. A family meeting is held to clarify advance
directives, as well as discuss the extent of illness and
prognosis with patient and his family.
•The Learner chairs the family conference while the
teacher observes.
•The Learner and teacher meet after the conference to
discuss how things went.
64

65. Role Play!
65

66. SIX STEP FEEDBACK MODEL
•Observe student behaviour/work
•Invite the learner’s self assessment of a clinical
encounter
•Describe the desired behaviour
•Make sure the student understands the difference
between current behaviour& desired behaviour
•Elaborate a plan to close the gap
•Follow-up on improvement
Brown, Hodges & Wakefield, 1995
Hodges, 2003
66

67. SIX STEP FEEDBACK MODEL -STRENGTHS
•Encourages self-assessment, a necessary skill for life
long learning
•Encourages delivery of feedback in a positive and
respectful manner
•Provides direction for improvement
•Provides follow-up to ensure that performance has
improved

68. SIX STEP FEEDBACK MODEL -
CHALLENGES
•May be too time consuming to use completely in some
clinical environments

69. OTHER FEEDBACK MODELS
•The SCOPME model*
•The Chicago model*
•The ALOBA model*
•SET-GO method of descriptive feedback
•IMPROVE Model
•One-minute clinical preceptor
*Mohanna, Wall & Chambers, 2004
69

70. QUESTIONS?
70

71. HOW ARE THINGS GOING SO FAR?
71

72. ENJOY YOUR BREAK!
72

73. Tips for Giving Feedback:
The “Problem” Learner
73

74. PREVENTION: STEP 1!
•Easier to prevent a problem than manage it –set ground
rules!
•Primary prevention
•Know learning expectations; orient learner; learning contract; reassess
halfway
•Secondary prevention
•Watch for warning signs; give specific feedback as early as possible (don’t
“watch & wait”), reassess
•Tertiary prevention
•Seek help early; don’t be a “martyr”; don’t give an undeserved passing
grade
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
74

75. WHAT IS A “PROBLEM LEARNER”?
•Negative connotation
•But, present in literature
•Defined as:
•“learners who perform significantly below their potential due to
specific difficulties”
Lucas & Stallworth, 2003
75

76. WHY DON’T WE HELP THE LEARNER IN
DIFFICULTY MORE OFTEN?
•Numerous Barriers to feedback…
•Lack skills
•Fear of exposing own inadequacies
•Fear of upsetting trainee
•Fear of doing “more harm than good”
•Fear reprisals through legal action
•Lack of time
McKimm& Swanwick, 2010
Lake & Ryan, 2005
76

77. SOAP APPROACH
•Subjective
•What made you consider there may be a problem with the student’s
performance?
•What do others think?
•Pattern of behaviour?
•What does the learner think –“how are things going with the
rotation”?
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
77

78. SOAP APPROACH
•Objective
•Need to document specificexamples of the problem
behaviour/interactions
•Write these down –student needs to know what exactly to improve
on
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
78

79. SOAP APPROACH
•Assessment
•Analyze subjective and objective components and formulate
hypotheses for why the student is in difficulty
•Several “differential diagnoses” to consider
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
79

80. Cognitive AffectiveValuative Environmental Medical
Poorknowledge
base
Learning
disability
Communication
barrier
Lack of
effort/interest
Anxiety
Depression
Fear
Anger
Expects
certain
grade/hours/w
orkload
Does not
value rotation
Conflicting
values with
patients/staff
Hospital vs.Clinic-
oriented
Timepressures
Patient population
Psychiatric
illness
Recent illness
Pre-existing
illness in poor
control (DM)
Substance
abuse
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998

81. SUPERVISOR & SYSTEM FACTORS
•Previous examples were “personal factors”
•There are also supervisor or system factors:
•Receiving no feedback/support
•Being given responsibilities beyond level of competence
•Interpersonal problems
•Overwork
•Exposure to patients with serious illness/death
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
81

82. SOAP APPROACH
•Plan
•Gather more data (if current situation is mild)
•Discuss problem with learner
•Contact school/training program
•Detailed, specific feedback –then, set plan for tackling the issues
and a time to re-evaluate performance
http://www.oucom.ohiou.edu/fd/monographs/difficult.htm, 1998
82

83. TIPS MODEL
•Categorizes problem learners as having affective, cognitive,
structuraland/or interpersonaldifficulties
Lucas & Stallworth, 2003
83

84. TIPS MODEL
•T: type and specify the ineffective behaviours
•Redirect these
•Provide detailed description about ineffective behaviours
•I: identify the category of difficulty experienced by the
learner
Lucas & Stallworth, 2003
84

85. TIPS MODEL
•P: perception vs. reality
•Describe the perception you have of the learner’s behaviour, but
acknowledge the learner may have a different view
•S: strategy for treatment/follow-up
•Discuss concerns with director/experts, as well as the learner
•Include consequences if student does not followsteps for
improvement
Lucas & Stallworth, 2003
85

86. GIVING THE FEEDBACK
•The critical intervention of having a private discussion
with the trainee requires:
•Setting aside time in a confidential setting;
•Getting student to speak first (positive critique);
Lake & Ryan, 2005
86

87. GIVING THE FEEDBACK
•Defining the issues involved (important, measurable, reproducible?);
•Determining the remediable cause(s);
•Agreeing on an action plan; and
•Monitoring outcomes and following up
•with frequent feedback
Lake & Ryan, 2005
Gordon, 2003
87

88. CALL FOR HELP!
**Remember! If you have
majorconcerns about a
learner, you have an
obligation as a teacher and
professionalto discuss these
with both the learner and the
appropriate program
contact(dean, program
director, etc.)
88

89. How to Role Play:
Ground Rules
89

90. GOALS OF ROLE PLAY
•Opportunity to practice giving feedback
•Obtain feedback on your feedback
•Identify difficulties encountered while giving
feedback
•Determine strategies to overcome these
90

91. GROUPS OF THREE
•Student
•Trainee in an ambulatory clinic
•Receiving end-of-rotation feedback
•Preceptor
•Supervising preceptor in an ambulatory clinic
•Observer
•Extra eyes and ears, keeper of field notes
91

92. FORMAT
•10 minutes: Review and prepare for role
•20 minutes: Give feedback!!
•15 minutes: Discuss within large group
–What worked well?
–What could be improved and how?
92

93. GROUND RULES
•Time-outs are encouraged!
–Rewind/fast-forward to repeat scenarios
–Rerun scenario with different feedback method
•Sharing /trading roles is encouraged!
–Rerun scenario with different roles
•Respect for each other is essential!
–Privacy must be respected
93

94. Feedback Away!
94

95. DEBRIEFING
•Preceptors …
–What was most difficult to discuss with the student?
–What was the easiest?
•Students …
–How did you feel when receiving feedback?
–What was your reaction?
•Observers …
–What went well?
–What problems did you notice?
95

96. Receiving Feedback
96

97. RECEIVING FEEDBACK
•Receiving feedback involves thinking of it as new
information, focusing on trying to understand it and
clarifying the meaning of the feedback.
Piccinin, 2003
97

98. FACTORS THAT AFFECT HOW
FEEDBACK IS RECEIVED
•Receiver’s Self Confidence
•the greater the receiver’s level of self confidence, the easier it is for
that person to respond to feedback
•Type of Feedback being Given
•major difficulty is receiving negative feedback
•Relationship between Giver and Receiver
•feedback from a trusted source is better received
Piccinin, 2003
98

99. STRATEGIES FOR RECEIVING FEEDBACK
EFFECTIVELY
•Preparatory Phase
•Keep in mind that feedback is valuable to all of us
•Receiving Phase
•Listen carefully to the entire feedback
•Try not to be defensive or to argue
•Paraphrase the content of the feedback
•Recognize the validity of the feedback
•Provide information to correct misinformation
•Say what you intend to do about the feedback received
Piccinin, 2003
99

100. STRATEGIES FOR RECEIVING FEEDBACK
EFFECTIVELY
•Follow up Phase
•collaboratively set definite dates or times to monitor progress toward
implementation of the action steps decided on.
Piccinin, 2003
100

101. RECEIVING FEEDBACK: SUMMARY
•Listen to the feedback
•Ask for it to be repeated if you did not hear
•Assume it is constructive till proven otherwise
•Pause and think before responding
•Ask for clarification or examples if statements are
unclear or unsupported
•Accept feedback positively
•Ask for suggestions of ways that you might modify
behavior
•Respect and thank the person giving the feedback
http://londondeanery.ac.uk, 2010
101

102. THE FEEDBACK TOOLKIT
102

103. QUESTIONS TO ASK YOURSELF…
•What was performed well and what could be performed differently?
•What specific behavioursdo I want to comment on?
•Can this behaviourbe modified and if so, what behaviourwould I like to see in
its place?
•What is the priority for improvement?
•How can I express respect and support for the learner as I provide feedback?
•Is it the right time and place?
Dent & Harden, 2009
Mckinley, Williams & Stephenson, 2010
103

104. SUMMARY: EFFECTIVE FEEDBACK
•Relevant
•Factual and Descriptive
•Timely, Frequent and Expected
•Specific and Focused on behaviour/performance
•Targetan alterable behaviour; must be able to “prove”
•Helpful with direction for improvement
•Balanced
•Collaborative
Dent & Harden, 2009
104

105. THE SANDWICH TECHNIQUE
•Reinforcing Statement: positive remark or
observation to learner
•Constructive Comment: constructive
observations ,
examples that need
change
•Reinforcing Statement: positive remark or direction for future
growth
Cantillon & Sargeant, 2008
105

106. PENDLETON’S RULES
•Briefly clarify matters of fact
•Learner states what was good about his/her performance
•Teacher states areas of agreement and elaborates on good
performance
•Learner then states what was poor or could have been improved
•Teacher then states what he or she thinks could have been
improved
Cantillon& Sargeant, 2008
106

107. REFLECTIVE FEEDBACK
CONVERSATION
•Teacher asks learner to share any concerns about a recently
completed performance
•Learner describes what they would have liked to have done better
•Teacher provides views on performance and offers support
•Teacher asks learner to reflect on what might improve situation
•Student responds
•Teacher elaborates on response, correcting if necessary
•Feedback ends with a clear and agreed plan for change
Cantillon& Sargeant, 2008
107

108. SIX STEP FEEDBACK MODEL
•Observe student behaviour/work
•Invite the learner’s self assessment of a clinical
encounter
•Describe the desired behaviour
•Make sure the student understands the difference
between current behaviour& desired behaviour
•Elaborate a plan to close the gap
•Follow-up on improvement
Brown, Hodges & Wakefield, 1995
Hodges, 2003
108

109. TIPS MODEL
•T: type and specify the ineffective behaviours
•Redirect these
•Provide detailed description about ineffective behaviours
•I: identify the category of difficulty experienced by the
learner
•affective, cognitive, structuraland/or interpersonal
Lucas & Stallworth, 2003
109

110. TIPS MODEL
•P: perception vs. reality
•Describe the perception you have of the learner’s behaviour, but
acknowledge the learner may have a different view
•S: strategy for treatment/follow-up
•Discuss concerns with director/experts, as well as the learner
•Include consequences if student does not followsteps for
improvement
Lucas & Stallworth, 2003
110

111. RECEIVING FEEDBACK: SUMMARY
•Listen to the feedback
•Ask for it to be repeated if you did not hear
•Assume it is constructive till proven otherwise
•Pause and think before responding
•Ask for clarification or examples if statements are
unclear or unsupported
•Accept feedback positively
•Ask for suggestions of ways that you might modify
behavior
•Respect and thank the person giving the feedback
http://londondeanery.ac.uk, 2010
111

112. Now, we would appreciate your
feedback!
112

113. LEARNING OBJECTIVES
•To describequalities of effective feedback
•To appreciatecommon barriers to giving feedback and
giving feedback in difficult situations
•To incorporatea feedback model in the form of a toolkit
framework with concise and meaningful take home
messages
•To developan increased comfort level with giving
feedback
•To demonstrateincreased ability to integrate newly
used feedback skills through role play
113

114. FEEDBACK WORKSHOP
•How did wefeel the workshop went?
•Overall impressions
•Material covered and well researched?
•Clarity, organization?
•Time allotment for each section?
•Role play/interactive component?
•Audiovisual aids and materials?
114

115. HOW DID THINGS GO (IN GENERAL?)
115

116. FEEDBACK WORKSHOP
•What did you feel went well?
•What could we change/improve on for next time?
•What (if anything) was missing?
•What one pearl will you take back to your
clinic/hospital/teaching from this workshop?
116

117. THANK YOU
•Thank you for attending our workshop!
•Thank you also to the INTAPT instructors for your help
and guidance
•Thank you to Rob Blain
•Toolkit creator!
117