Feedback is a pretty hot topic in our residency right now. It has a lot to do with the relatively recent change in evaluation, aka the beloved milestones. I have had many conversations with residents about the desire for more feedback. My belief is that there needs to be a change in culture in order to foster an environment where feedback is a priority. If it is expected and the environment is open to it, it will occur more often. Like most things in Education giving feedback is a type of skill which can be practiced and perfected. Below I will go over some concepts and ideal forms of feedback.
Types of Feedback
There are two general types of feedback in education:
Formative– corrective or encouraging feedback about a particular area or instance.
Summative– an overall evaluation or overview of performance.
For the most part I believe learners want more formative feedback. They are used to getting overall assessments and evaluations but want to know particulars about their performance in real time. I know this is where our program can improve. The more mature or advanced the learner usually dictates the kind of feedback they wish to receive. Education research has shown that novice learners want to hear feedback as long as it is positive but as learners become more expert they would prefer corrective or negative feedback so they can improve.
One of the best ways to change culture is to understand the current state. Why is it so difficult to give or ask for feedback?
-Uncomfortable: It can be difficult to give feedback especially when it is corrective often because of the negative feelings it produces.
-Consequences: There may be repercussions for negative feedback such as difficult interactions in the future or even poor evaluations. Evaluations may drive promotion in many academic centers.
-Time: Feedback takes time and in a busy ED this becomes less of a priority.
-Skill: Educators may be bad at giving feedback and like many other things in medicine this is a skill that can be developed.
-Importance: Many educators may not realize the importance or value feedback.
-Fear of failure or being told they failed
-Inconsistent: learners often get inconsistent feedback and education especially in the ED with variability in management
-Environment: often the clinical area is not ideal for feedback but this is the best place to give immediate, formative feedback
-Schedule a meeting and identify as feedback
-Prepare by reviewing the learners evaluations and past meetings
-Location: the location should be neutral or favor the learner. It should be confidential and private
-Self Assessment is a good way to start. It establishes how the learner perceives their situation and likely their goals.
-Respond to the self assessment and you can start the discussion from this point.
Diagnosis and Feedback
-Specifics need to be the main focus of the discussion and ideally it should be observed behavior by the educator.
-Limit the content of a single feedback session. Trying to tackle too much data or information will not accomplish anything.
-Ideally, focus on modifiable behavior. The below are listed from easiest to hardest attributes to modify:
Time and work management
-Work together and suggest solutions for the future.
-Apply Goals in earlier discussion to the future planning. This will help buy-in of the resident
-Often identifying a mentor or coach to help in achieving progress is helpful
-Discuss specific ways to apply corrective actions
-Reaffirm worth and ability to improve
-Schedule a follow up
-Don’t email feedback
-Avoid an audience
-Identify sessions as feedback. Often learners may not realize they are receiving feedback unless they are being told.