NACT conference 2011
Feedback
Dr Jill Edwards MSc FRCGP
Dr Nicki Williams MSc FRCGP
Promoting Excellence in Family Medicine
“Feedback”
What is it?
Promoting
Excellence in
Family Medicine
Feedback in Clinical Education
Specific information about the comparison
between a trainee’s observed performance and
a standard, given with the intent to improve the
trainee’s performance
Promoting
Excellence in
Family Medicine
Van de Ridder et al 2008 What is Feedback in Clinical Education?
Medical Education 42 no 2 p189
Thoughts about feedback
Function of feedback
“Positive Feedback” and “Negative Feedback”
Effective feedback
Promoting
Excellence in
Family Medicine
Function of Feedback
Motivate
Encouragement
To change
To continue doing effective behaviour
Developing self esteem
Benchmarking
How am I doing?
Increasing insight, capability self awareness and
effectiveness
Sharing expectations
Promoting
Excellence in
Family Medicine
Johari’s Window
Known to self
Unknown to self
Known to others
FREE SELF
Open to self & others
BLIND SELF
Seen by others, but not by
self
Unknown to others
HIDDEN SELF
Seen by self, but not by
others
UNKNOWN SELF
Unseen by self & others
Promoting
Excellence in
Family Medicine
Motivation
Most people have a basic need to know how
well they are doing
The expectation of success is fundamental to
motivation and effort
Motivation and effort  when goal is
perceived as almost certain or impossible
Promoting
Excellence in
Family Medicine
The power of positive
expectations
“I shall always be a flower girl to Professor
Higgins because he always treats me as a
flower girl …….. But I know I can be a lady to
you because you always treat me as a lady and
always will “
George Bernard Shaw
Pygmalion
Promoting
Excellence in
Family Medicine
Problems with feedback
Doesn’t happen
Positive and negative feedback doesn’t effect
change in performance in a constant manner
Poor feedback can damage motivation
Poor feedback can effect self efficacy – promote
learned helplessness
Promoting
Excellence in
Family Medicine
RELATIONSHIP
DIAGNOSTICS
Data Gathering &
Interpretation
Communication &
Consulting Skills
Making a Diagnosis /
Making decisions
Practising Holistically
Clinical Management
Working with Colleagues
& in Teams
Professionalism
Maintaining an Ethical
Approach to Practice
Fitness to
Practise
Community
Orientation
Promoting
Excellence in
Family Medicine
WPBA competencies
Primary Care
Administration
& IMT
Maintaining Performance,
Learning & Teaching
MANAGEMENT
Managing Medical
Complexity
RCGP CSR Quality Management Pilot
• 250 Clinical Supervisors Reports (CSRs)
• 5.8% of the total
• submitted between 1 January and 31 March
2010
• assessed by the External Advisors
Promoting
Excellence in
Family Medicine
RCGP CSR Quality Management Pilot
CSR acceptable
CSR needs further information
a) Free text comments are specific and
constructive
c) There is little or no formative feedback to
the learner
b) Where underperformance is noted or
concerns are highlighted, free text comment
is made
d) Where grades are ‘borderline’ or ‘below
expectation’, insufficient free text comment
is made and little or no detail about
concerns provided.
Promoting
Excellence in
Family Medicine
RCGP CSR Quality Management Pilot
There is little or no formative feedback to the
learner: 51.6%
Free text comments are specific and
constructive: 44%
Promoting
Excellence in
Family Medicine
Features of Effective Feedback
Positive
 Mutual Respect
 Specific Praise or
criticism
 A genuine desire to
help
 Allowing time
 Against previously
discussed criteria
 Learning contract
Promoting
Excellence in
Family Medicine
Negative
Public humiliation
Comments on
personality
No two way discussion
Lack of personal
interest
Too general
Too little too late
Promoting
Excellence in
Family Medicine
Models of Feedback
Pendleton’s Rules
Sandwich approach
Positive (reinforcing) v Negative (corrective)
Regulatory focus
Promoting
Excellence in
Family Medicine
Bespoke
Feedback
Bespoke Feedback
Depending on the regulatory framework
(Higgins)
Prevention – vigilance & concern with
punishment – ‘have to’ – negative feedback
Promotion – eagerness & concern for rewards
– ‘want to’ – positive feedback
Promoting
Excellence in
Kluger
AN &
Family Medicine
Van Dijk D. Feedback, the various tasks of the doctor, and
the feedforward alternative. Medical Education 44 no 12 p1166
Criteria for feedback
Descriptive
of the behaviour rather than the personality
Specific
rather than general
Sensitive
to the needs of the receiver as well as the
giver
Directed
Towards behaviour that can be changed
Timely
Given as close to the event as possible
Selective
Addressing one or two key issues
Promoting
Excellence in
Family Medicine
Effective Feedback
Effective Feedback Ineffective feedback
Preserves or enhances the
learner’s self respect
Feedback about good
Reduces the learner’s self respect

X

X
performance
Feedback about
performance that
needs to be or could
be Promoting
improved
Excellence in
Family Medicine
Your turn!
Promoting
Excellence in
Family Medicine
Gordon Ramsay giving feedback …
So.. How did he do?
Descriptive?
of the behaviour rather than the personality
Specific?
rather than general
Sensitive
to the needs of the receiver as well as the
giver
Directed?
Towards behaviour that can be changed
Timely?
Given as close to the event as possible
Selective?
Addressing one or two key issues
Promoting
Excellence in
Family Medicine
In Groups of three
One ‘Gordon’, one ‘trainer’ feeding back to
Gordon on his feedback and one observer.
How was it for you? (Gordon then trainer then
observer.)
In the same group, try different ways to make it
more effective
Summarise learning points to the main group
Promoting
Excellence in
Family Medicine
Learning points
What might YOU do
differently next time?
Promoting
Excellence in
Family Medicine
Supporting
COGPED
Excellence
In
Medical
Education
9th National Multi-specialty Conference
for Heads of Schools, Programme Directors, Directors of
Medical Education
25 & 26th January 2011