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Behavioral feedback for clinical learners

My U of Utah Academy of Health Sciences Educators talk from 9/18/2014

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Behavioral feedback for clinical learners

  1. 1. Providing Effective Behavior-oriented Feedback Amalia Cochran, MD, FACS, FCCM 18 September 2014 University of Utah AHSE Twitter: @AmaliaCochranMD Amalia.cochran@hsc.utah.edu
  2. 2. Objectives • At the conclusion of this session, learners will be able to: – Explain why feedback failures occur – Discuss characteristics of “strong” feedback – Demonstrate one new facet of providing effective feedback to a clinical learner
  3. 3. Let’s start with an example… • Julie often appears disinterested in her current clinical rotation/ – Frequently misses details about her patients – Rarely participates in learning discussions – Leaves as early as she can – Documents patient encounters incompletely – Has stated disinterest in current patient population
  4. 4. WHAT WOULD BE INEFFECTIVE IN PROVIDING HER WITH FEEDBACK?
  5. 5. WHAT WOULD BE EFFECTIVE IN PROVIDING HER WITH FEEDBACK?
  6. 6. Setting the Stage for Feedback
  7. 7. Be clear with your expectations • Opening discussion: – Your expectations for the day – The learner’s expectations for the day • Create a plan for feedback with the student – Following each encounter? – End of the day? • Always have an end-of-day wrap-up – Establish goals for the next session with input from the learner
  8. 8. Defining feedback It’s not as easy as you think…
  9. 9. Ende (1983) • Differentiates feedback from evaluation • “Information describing students’ or house officers’ performance in a given activity that is intended to guide their future performance in that same or a related activity.” • Clearly can be extrapolated to other health sciences professions with a clinical orientation • Behaviorally based!
  10. 10. The feedback conundrum • Learners want feedback – Helps them to gauge their performance – Helps them make plans for improvement – (Ideally) fosters skills of self-directed/ lifelong learners who are reflective about their practice • Learners are dissatisfied with the feedback that we tend to provide
  11. 11. Hesketh and Laidlaw, 2002 WHY FEEDBACK FAILURES OCCUR
  12. 12. Lack of time
  13. 13. Inconsistency of feedback
  14. 14. Fear of criticizing
  15. 15. Fear of being criticized
  16. 16. Not recognized as feedback
  17. 17. Inability to respond to “feedback”
  18. 18. Denial of feedback given
  19. 19. Van de Ridder, et al., 2008; Ramani & Krackov, 2912 HOW DO WE PROVIDE STRONG FEEDBACK?
  20. 20. Establish a respectful learning environment
  21. 21. Communicate Goals and Objectives for feedback
  22. 22. Base Feedback on Direct Observation
  23. 23. Start with Self-Assessment
  24. 24. Focus on performance
  25. 25. Confirm understanding by the learner
  26. 26. Plan of action and re-observation
  27. 27. AND NOW…HOW ABOUT THE STRUGGLING LEARNER?
  28. 28. Key References • Hesketh and Laidlaw, 2002. “Developing the Teaching Instinct: Feedback” Medical Teacher 24: 245-248 • Ramani and Krackov, 2012. “Twelve Tips for giving feedback effectively in the clinical environment.” Medical Teacher 34: 787-791. • Van de Ridder, et al., 2008. “What is feedback in clinical education?” Medical Education 42: 189-197.

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