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Tools & Strategies for Providing Effective Feedback Facilitators: Kristin Vaga, Eric Tseng, Ian Porter

Conflicts of Interest — The presenters have no conflicts of interest to declare.

Mitigating Potential Bias — Discussion of any issues is encouraged during this workshop.

Agenda Time Activities 8:00 – 8:30 Introductions 8:30 – 8:40 Pre-Test 8:40 – 9:00 Presentation: The Importance of Feedback 9:00 – 9:30 Activity # 1: Effective & Non- effective Feedback 9:30 – 10:00 Break 10:00 – 10:20 Presentation: Tools, Strategies & Frameworks 10:20 – 11:00 Activity # 2: Practice Giving & Receiving Feedback 11:00 – 11:20 Activity # 3: Case Studies 11:20 – 11:30 Post Test & Wrap-Up

Facilitators Ian Porter Eric Tseng

Facilitators — Kristin Vaga

Assessment — Assessment FOR Learning — Self Assessment — Assessment OF — Summative Learning — Formative — OSCE — Reliability — MCQ — Validity — Mini-Cex — FEEDBACK — Portfolio — Course Evaluation

FOCUS “Lets Do Feedback” -Ian, Eric & Kristin

Feedback — “An essential element of the educational process… enables learners to achieve program goals by reinforcing good performance and providing the basis for remediation when needed.” Ramani, S., & Krackov, S. K. (2012). Twelve tips for giving feedback effectively in the clinical environment. Medical Teacher, 34(10), 787-791. — “Feedback is often very general and not helpful to students. Even when faculty think they have given detailed feedback, students often consider the process to be inadequate.” Brukner, H. (1999). Giving effective feedback to medical students: A workshop for faculty and house staff. Medical Teacher, 21(2), 161-165.

Feedback — “Giving effective feedback is a skill that can be learned through practice”. Brukner, H. (1999). Giving effective feedback to medical students: A workshop for faculty and house staff. Medical Teacher, 21(2), 161-165.

Goal — To improve the learner’s ability to give effective feedback in a clinical setting

Objectives — Knowledge: List 5 characteristics of effective feedback — Skill: Distinguish between cases involving effective and non-effective feedback techniques — Attitude: Recognize the importance of providing effective feedback

2 Truths & A Lie — Think of two truths and a lie about yourself to share with the class (1 sentence or less) — Write your name at the top of the paper followed by — 1 — 2 — 3 — Beside each # write 1 word that describes each sentence.

Learner Profiles (What We Learned) Instructional Setting? Types of Learners? • Clinic • Medical trainees • Small Group • Health professions • Lecture • Colleagues • Ward / Bedside Comfort Providing Prior instruction in Feedback? Providing Feedback? • Not at all à • Yes somewhat • No comfortable

Pre-Test

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The Importance of Providing Effective Feedback

What is "Feedback"? — " Feedback " — Ende (1983): "information that a system uses to make adjustments in reaching a goal" — Swanwick (2014): "a way in which learners become aware of the gap between their current level of knowledge or skill and the desired goal" — Critical component of formative assessment — Ende (1983): "Feedback provides information, not judgment"

What is "effective feedback"? — " Effective Feedback " — Archer (2013): "Feedback in which information about previous performance is used to promote positive and desirable development" — Swanwick (2014): "Effective feedback is achieved only when the student takes action to narrow the gap... [the students] are empowered to take the necessary action to achieve"

Effective feedback is a collaboration Learners Teachers — Tensions of providing feedback (Archer): — Acknowledging psychosocial needs of recipient — Ensuring feedback is honest and accurate

Why do we need to provide effective feedback? 1. Increasing the insight of learners into their own skills, capabilities, and areas for improvement 2. Facilitating the achievement of physician competencies and improvement 3. Accommodating the recipient emotional response to feedback

1. Increasing learner self- awareness — Self-assessment by learners is poor in the absence of external input — Feedback can reinforce good performance while prompting remedial action when necessary — A culture of regular feedback encourages awareness of performance, guides future actions (Krackov & Pohl 2011)

2. Facilitating achievement and improvement — Feedback empowers learner to self-regulate his own learning (Nicol & MarFarlane 2006) — Pairing detailed, specific feedback with opportunities to improve (Ramani 2012): achieving milestones — Helps learners gauge their own progress

3. Watching the emotional response to feedback — Disconfirming feedback can "threaten self- perceptions" (Sargeant 2011) — Defensiveness can prevent incorporation of helpful feedback — Anxiety from faculty about causing emotional distress, especially when not formally trained (Brukner 1999)

Barriers — Purpose of feedback unclear — Setting an appropriate time or place — Lack of training — How to observe — How to give constructive feedback — Expectation of one-way communication Ramani (2012) Med Teach

Summary: Importance of Effective Feedback — Effective feedback provides learners with knowledge about own performance to drive improvement — Provision of effective feedback enables: — Improved self-insight of learners — Achievement of competencies — Respect for emotional response of the learner

Activity #1 — Effective vs. Non-Effective Feedback Characteristics

Effective Feedback — “Think Pair Share” — Reflect on personal experience receiving feedback — Should be an actual event/teacher — Identify 2 characteristics — Share with a partner

Non-Effective Feedback — Repeat same activity focusing on a negative feedback experience. — Identify 1 characteristic.

Share — Partners share effective & non-effective characteristics!

Tools, Strategies & Frameworks 1. Specific features of effective feedback 2. Practical models for providing effective feedback — Pendleton’s rules — One-minute preceptor — The Chicago model — ECO model

Constructive feedback — Importance of constructive feedback — Balance between comments on strengths, and comments on areas to improve — Ideally both High Support and High Challenge High support High Low challenge challenge Adapted from: Low Mohanna et al support (2011)

Constructive feedback High support Safe, general, Focused, potentially attentive, patronizing potentially threatening Low High challenge challenge In passing, Critical - nothing specific, induces dismissive defensiveness, potentially paralyzing Adapted from: Mohanna et al Low (2011) support

Effective Feedback Strategies — Positive learning environment — Clear goals and objectives — Timely — Learner self-assessment — Based on direct observation — Focus on specific behaviours — Action plan

Effective Feedback Strategies Positive learning environment — Two-way: teachers and learners as partners, working together — Common goals — Trust and respect — Private environment, gentle, supportive, caring

Effective Feedback Strategies Clear goals and objectives — Clear objectives and expectations for the learning activity

Effective Feedback - Strategies Timely — Opportunity for learner to work on improvement immediately — Teacher and learner are able to remember the learning event and specific behaviours

Effective Feedback Strategies Learner self-assessment — Start feedback with self-assessment — Learner may raise topics that teacher was planning to discuss — Initiates dialogue — Feedback may be more acceptable to learner — Learner may be more critical of themselves — Controversial? - self-assessment possibly flawed

Effective Feedback – Strategies Based on direct observation — Direct observation from the teacher providing the feedback, rather than from second-hand information — Feedback more acceptable to learner — Be wary of subjective comments — Identify them as such if they are used