Giving Feedback Effectively

Overview

  • Providing feedback is professional responsibility as a preceptor
  • Create a stimulating environment where feedback is encouraged and can be successful
  • Be specific!
    • Focus on observed events/issues
    • Discuss specific behaviors and suggestions for improvement
  • Encourage student to provide thoughts on their own performance and areas for improvement
    • Feedback should be 2-way street!
  • Overcome barriers to successful delivery of feedback
    • Be clear with goals and expectations up front
    • Make feedback regular part of each day
    • Address concerning behaviors/issues ASAP and provide meaningful solutions
    • Focus feedback on your area of expertise
    • Sandwich technique for delivery of negative feedback

What is feedback?

  • Objective and constructive sharing of observations, suggestions, and recommendations with a student
  • Constructive feedback helps student identify areas where they need to make changes and improvements
  • Goal of feedback is to change bad or poor behavior, reinforce good behavior, and improve skills

What is "good feedback?"

Good feedback is not

  • Non-specific comments “Read more”: this does not help the student identify specific areas of knowledge deficits
  • Harsh criticism Feedback should be constructive for it to be impactful
  • Formal assessment Feedback can and should be given throughout the student’s rotation, not just at the end as part of a formal assessment

Why is feedback important?

  • Professional responsibility to help students improve and grow during their rotation
  • Allows the student to implement change and for you to accurately assess his/her willingness to respond to feedback
  • Students often appreciate feedback and feel more engaged and valued during their rotations

How can you give effective feedback?

  • Establish an environment where feedback is regularly dispensed and expected by the student
  • Clearly define that you are giving feedback
    • “I’d like to give you some feedback about …”
  • Prepare student for negative feedback as necessary
    • Warning shot
    • “I’d like to give you some feedback about something that is a little concerning to me”
  • Propose ideas for moving forward and making improvements
    • “In the future I would like to see …”
    • “Next time...”
  • Ensure that the student has a clear understanding of your expectations and educational goals you have set for them
  • When giving feedback, ensure that you do this in a timely manner
    • Most impactful when given immediately after concerning event, not a week or two later
  • Feedback should be given in private with minimal distractions when possible
  • Base feedback on first hand observations and provide an example, do not base on hearsay
  • Use non-judgmental language
    • Focus on the action and consequences rather than accusing the student of poor judgement
  • Be specific and give examples
    • “Your work-up and management of patient x was problematic because…”
  • Reinforce positive behaviors
    • “Your interactions with the patients and their families today was exemplary”
  • Address behaviors/concerns since the last feedback
    • Do NOT perseverate on old concerns or previous mistakes unless they continue to be problematic
  • Only address a few behaviors/concerns at one time
    • Attempting to address multiple issues will overwhelm the student and is not effective in prompting change on his/her behalf
  • Discuss only behaviors/concerns which can be modified and improved
    • Giving feedback on fundamental personality characteristics which are not modifiable is not productive and can lead to feelings of resentment
  • When possible, have the student self-assess and identify areas they feel they can improve and/or problematic decisions they have made
    • You can build off this and offer suggestions for improvement
  • At end of feedback session, be sure to summarize and review next steps
    • To improve, you will do x and x by x time
      • Arrange for follow-up as necessary
        • Build in time to review progress either at a set time or mid-way through the rotation
        • “Let’s come back to this again in 1 week to discuss your progress in implementing these changes we have just discussed”

What are some barriers to giving effective feedback?

  • Uncomfortable with confrontation
    • Sandwich technique
      • Start and end with positive feedback, negative feedback given between positive comments
    • Mentally rehearse the discussion until comfortable discussing with the student
    • Speak to Marquette PA Program representative for further insight
  • Belief that things will improve on their own
    • Rarely is this the case
  • Student has a “difficult” personality
    • Focus on the behavior, not the person
      • “Your style of interaction was taken offensively by the listener, which I’m sure was not your intention” vs “You’re being rude”
    • Ask the student to self-assess to see if they understand the issue
    • Reach out to the PA program if you have serious concerns about a student’s personality and ability to function at a professional level
    • Goal is to improve behaviors and skills, not to change basic personality characteristics
  • Angry/Sad/Defensive student
    • Reframe the negative feedback
      • Encourage that change will result in a positive outcome for the student in their future interactions with patients/staff/etc.
    • Give the student time to process the information and re-address later
    • Keep the conversation on track and specific
      • Focus on specific areas of change and expected results
  • Timing
    • Make feedback a regular and expected occurrence
      • Schedule specific day/time if necessary
    • Address issues when they arise and are fresh, often only takes a few minutes of time and impact can be significant
    • Keep feedback brief by focusing on 1-2 specific behaviors/events and what the student can do differently next time
  • Uncertain about own knowledge base
    • Focus feedback on what you are comfortable with in medical knowledge, communication, professionalism, and practice management
    • Model behavior for student
      • Look up information together
      • Encourage student to look up independently and meet at future designated time to review together
      • Get help from consultant service
        • Demonstrates how to handle a complicated situation when you are unsure of what to do