feedback

1. feedback Transition day 2014 feedbak feedback kcabdeef

2. Feedback • A system by which some of the energy from the output of a communications circuit is returned to the input circuit, either to increase or reduce the power or to regulate the quality of the signal. • A sensory or perceptual report of the result of any behavior which may reinforce or modify subsequent behavior.

3. “Feedback is the control of a system by reinserting into the system the results of its performance. If the information which travels backwards from the performance is able to change the general method and pattern of performance, we have a process called learning. " –Jack Ende

4. Feedback Operant conditioning? (Type II reflexes)

5. What do these nice people have in common?

6. All are elite, expert performers

7. All are elite, expert performerswho know that practice makes perfect

8. In theory there is no difference between theory and practice... -Yogi Berra

9. In practice, there is. -Yogi Berra

10. Expert, Elite Performer Cognitive NOVICE Miller GE. Academic Med. 1990.

11. Expert, Elite Performer Skills NOVICE Miller GE. Academic Med. 1990.

12. ORIME Instructor Expert/Master Manager Proficient Ability Interpreter Competent Reporter Advanced Beginner Observer Novice Dreyfus SE, 1980

13. The acquisition of superior performance in medicine is closely related to engagement in practice with feedback during medical training.” -Ericcson, Academic Med 2004

14. If you don’t know where you’re going, you might end up someplace else. -Yogi Berra Feedback can be your GPS

15. Patient care: Information Management-recording & presenting Data Gathered from History and Physical Exam • Presentations fluent, well organized, clinically precise • Able to discern relevant details while staying concise. • Presentations disorganized. • Difficulty discerning amount of detail needed. Imprecise, Assessments not well defended

16. You can learn a lot by watching -Yogi Berra

17. Feedback: evaluation of performance facilitates coaching

18. If I’ve told you once I’ve told you a thousand times! It’s “i” before “e” except after “c”!

19. Medical MathFeedback = teaching

20. Feedback

21. SO WHAT PART OF MY INSTRUCTIONS DID YOU NOT UNDERSTAND?!?!? I SAID THAT’S “i” BEFORE “e” EXCEPT AFTER “c”

22. What would be effective feedback for you? We don’t all receive feedback in the same way. If you have received feedback that was ineffective, why was it so? If you received feedback that was effective, how was it different?

23. For example, The case of Millie Kablunschki

24. Was this feedback? “A sensory or perceptual report of the result of any behavior which may reinforce or modify subsequent behavior. “

25. Feedback occurs when a recipient gains insight into what they did and is instructed in its consequences and ways to improve Feedback in this case? The teacher said: 1. Student did not focus on the patient first 2. Student did not give pertinent findings 3. Student was reminded that vitals are always pertinent 4. Student was re-taught that a CXR cannot make a diagnosis 5. Student was informed about consequences

26. Was it effective feedback? That’s up to the receiver

27. Do we recognize feedback? We receive a lot of feedback every day • Learn to identify it • Learn to act on it Most feedback is not received in formal, “sit-down” settings It is not personal • Our dress, behavior, speech, habits all affect how we perform as a professional • Tone of voice, facial expression, email composition can sometimes overshadow the message – • tune in to the message

28. Effective feedback should be: 1. Delivered face to face 2. Delivered in appropriate doses 3. Delivered in a timely fashion

29. It’s all in the eyes

30. Effective feedback should be: 1. Delivered face to face 2. Delivered in appropriate doses 3. Delivered in a timely fashion

31. “I must talk to you about your nose hair.”

32. Effective feedback should also be: 1. Specific, Concrete, Objective • Ask for examples. Response? “vital signs need to be in every note.” • Facts are difficult to dispute, focus on work product, i.e. patient care 2. Professional – Respectful in voice, words, timing, location • We are future colleagues 3. Explanatory, educational • “Be sure to check the chart. As you learned from Mrs. Kablunschki there is no need to order labs that have been done recently. 4. A plan for improvement • Focus on the next step in learning, improved performance, how to make our work/patient care better

33. Make sure it is specific • If student Nonny hears: “good job” • Nonny will assume he is doing “honors” work • If Noddy hears: “good job” • Noddy will assume she is barely keeping up • Feedback given in a stressful situation may require repetition (and medical school is stressful…) • E.g. “Remember yesterday I told you that vital signs are always pertinent so I expect you to report them on every patient.”

34. What to know about giving feedback Students also give feedback It needs to be: • objective, timely, professional, explanatory, and a plan for improvement We need to be able to trust the feedback we receive • Provider must be observant, competent and objective to provide the appropriate feedback • Students must be the same

35. What to know about giving feedback

36. What to know about feedback 1. Skill development (learning) depends on getting practical and timely feedback based on direct observation. 2. We can influence quantity and quality of feedback we get. Take initiative and be prepared to invest in the beginning Identify, set and share learning goals Create opportunities for practice with observation Schedule times for feedback 3. Pick up on the positive, catch the message in any delivery 4. Tune in and respond to feedback given

37. You’ve got to be very careful if you don’t know where you are going, because you might not get there. -Yogi Berra

38. What’s the point? Keep the goal in mind – better patient care Because it isn’t about me, It is about how best to serve my patients

39. Excuse me for interrupting, but it’s “i” before “e” except after “c.” (Weird isn’t it?)

40. The ends