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We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author. 2012 by the author
ERS Annual Congress Vienna
15 September 2012
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observer, you want to provide feedback as soon as possible (e.g. following the observation) rather than several days later. Table 1. Advantages of effective feedback 1. Helps to clarify areas that need improvement for the learner (and teacher) 2. Prevents errors turning into habit 3. Provides learners with an accurate perception of own performance 4. Conveys an attitude of concern and interest between instructor and learner Table 2. Obstacles to feedback a. When feedback is based on goals different from that of the learner b. Perceived by the learner as personal judgment c. Inconsistent message is delivered d. Provided in an inappropriate environment e. Time constraints Table 3. General principles of feedback Give specific examples. Non-judgmental. Provide descriptive, rather than interpretive comments (Box 1) Focus on (modifiable) behaviour rather than interpretation (box 2) Language used should reflect observation rather than inference i.e. separate behaviour and interpretation (Box 2) Choose an appropriate time to provide feedback Provide feedback in a quantity that can be coped with Check that the provided feedback is understood Avoid collusion i.e. attempting to seek approval/agreement Make interpretations tentative Suggestive vs prescriptive Box 1. Difference between interpretive (judgmental) and descriptive (non-judgmental) language Interpretive or judgmental Descriptive or non-judgmental language language The beginning was awful, you just seemed to At the beginning you were looking at the notes, ignore her. which prevented eye contact Its no good getting embarrassed when patients I noticed you were very flushed when she spoke talk about their sexual history about her husbands impotence, and you lost eye contact Box 2. Examples of terms that describe behaviour and interpretation during feedback Behaviour Interpretation Bored Arms folded Good rapport Legs crossed Embarrassed Flushed cheeks Amused Rapid voice tempo Disgusted Slow steady breathing I saw you look at your watch and thought you might be bored I saw him talking with his hand over his mouth and wondered if he was lying
General guidelines for providing and receiving feedback after a (clinical) presentation
Generally, it is difficult for an individual to develop or improve his or her presentation skills without practising in a safe environment and receiving feedback on his or her performance. Ideally, when giving feedback, the presenter should be invited to comment on his or her performance before the observer does. It is better to ask presenters to comment on their own performance first as they are
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usually self-critical and are likely to raise issues that the observer has also identified. Helpful guidelines for providing and receiving feedback after (clinical) presentations are provided below.
Providing feedback
As the person providing feedback, ensure that you: Invite the presenter to speak first. It encourages the ability to critically appraise ones performance and self reflection Be specific with the comments you provide. A remark such as your presentation appeared chaotic is less helpful compared to the remark I was distracted when you appeared to lose track of your presentation and started searching for the correct slides Allow for a good balance of positive and negative feedback. An excess of positive feedback increases the chances of losing sight of opportunities for improvement, while an excess of negative feedback induces discouragement and loss of motivation. Direct feedback at behaviours that the presenter can improve. Providing critique on an individuals speech impairment for example, is not beneficial. Seek agreement with audience. Check if the content of your feedback agrees with the observations of other members of the audience and vice versa
Receiving feedback:
As the person receiving feedback, strive to: Listen to feedback without comments. You hear more when you concentrate on listening instead of attempting to defend your action and/or explain behaviour When necessary, ask for clarity when the person providing feedback is done. You should be certain that you understand the content and source of the provided feedback. Initiate own suggestions and actions for improvement. Explain clearly which specific actions you intend to take, what new ideas you would like to try out etc. Take notes. You can these later to reflect on the content and agreements made during the feedback discussion.
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Conclusion
Feedback is a generic skill that can be learned and when provided correctly, can improve learning outcomes and enable learners to develop an analytical approach to learning. The best way to learn how to give effective feedback is to practice. A structured feedback model may feel artificial and unhelpful until the technique has been mastered and developed into familiar vocabulary and/or series of phrases to help. However when mastered, it can be effectively used in settings such as formal educational supervision, clinical presentations as well as in day-to-day situations with colleagues, staff and patients. Ultimately, feedback is about communication; the key skills are to listen and ask, not to tell and provide solutions [1].
References
1. King J. (1999) Giving Feedback. BMJ 318:2. 2. Nadler DA. (1977) Feedback and Organisation Development: Using Data-based Methods. Reading, MA: Addison-Wesley. 3. Knowles MS. (1980) The Modern Practice of Adult Education: From Pedagogy to Andragogy. 2nd ed. Chicago: Follet Publishing Co. 4. Black P and William D (1998) Assessment and classroom teaching. Assessment in Education 5:7-73. 5. Rolfe I and McPherson J (1995) Formative assessment: How am I doing? Lancet 345:837-9. 6. Hyman RT. (1980) Improving Discussion Leadership. New York: Teachers College Press. 7. Pendleton D, Schofield T, Tate P, Havelock P. (2003) The New Consultation. Oxford University press, ISBN 0-19-263288
Additional reading
1. Teaching made easy, Chambers and Wall, Radcliffe 2000, ISBN: 1-85775-373-9 2. Teaching and learning communication skills in medicine, Kurtz, Silverman and Draper, Radcliffe 1998, ISBN: 1-85775-2723. Adult and continuing education, Jarvis, Routledge 1995, ISBN: 0-415-10242-1 4. Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press; 1984.
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MOTIVATING LEARNING
Adult learners are motivated by intrinsic factors and more likely to learn when: Instruction is problem centered Is in a supportive environment Learning is experience orientated Learning is active versus passive Effective feedback is provided
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2. SUPPORTIVE ENVIRONMENT
Non-threatening/non-judgmental environment Mutual trust and respect Encourages self-confidence and initiative TIPS Introduce yourself and learn names Be available and approachable Respond constructively to problems or questions
AND be patient
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4. ACTIVE LEARNERS
Learners more motivated to learn
Attention is maintained Retention is enhanced
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FEEDBACK WHAT?
Interactive process aimed at reinforcing positive behavior and providing specific guidelines for the future
FEEDBACK WHAT?
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., 1998)
FEEDBACK
Causes change in (certain) behaviours
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FEEDBACK WHY?
Insight in performance Reinforcement (success breeds success) Better understanding and application of knowledge
FEEDBACK WHO?
Goodmentor Friend Patient Respectful
Busarietal.,2005
FEEDBACK WHEN?
Direct(assoonaspossible)
Calmmoment
Scheduleanappropriatemoment
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FEEDBACK HOW?
TYPE
Hownot: feedbackasacomplicationreviewsession!
FORMAL FEEDBACK
THINGS TO KNOW
Plan ahead (prospective) Views should be personal Give specific examples Appropriate timing Focus on modifiable behaviour Descriptive (non-judgmental) comments Encounter resistance: stop and listen Concise & clear Balance positive and negative comments
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What can be improved - Presenters perception - Observers perception Summarize - Positive points - Points for improvement
Invite the presenter to speak first. Be specific with your comments. Balance positive and negative feedback. Direct feedback at improvable behaviour. Seek agreement with audience.
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WRAPUP.
FEEDBACK GUIDELINES
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