On Delivering (And Receiving) Feedback

1. The Teaching Center On Delivering (And Receiving) Feedback John T. Benjamin MD The Teaching Center UNC Department of Pediatrics

2. Teaching Thoughts The Teaching Center • “Teaching is not a lost art, but the regard for it is a lost tradition.” Jacques Barzun • “Teachers need to be and teach learners how to be stewards for self-directedness.” John Parboosingh MD

3. The Teaching Center

4. Why Give Feedback? The Teaching Center • An essential part of training and of measuring teaching effectiveness. • Should encourage self-reflection, raise self-awareness; help students plan for future learning and practice keeping self-image intact. • Can help prevent distress (burnout)

5. Feedback vs. Evaluation The Teaching Center • These two terms are not equivalent. • Evaluation is what is done at the end of the experience with the learner. Feedback should be happening as go along.

6. 2 Types of Feedback The Teaching Center • Formal: scheduled; this is incorporated into the evaluations of learners. • Informal: daily as relates to specific events: presentations, write-ups, behavior, etc.

7. How often should formal feedback occur? The Teaching Center • Learners state that doesn’t happen often • Teachers state it occurs more often than learners think. Recommendation: Always label: “now you are getting feedback”

8. Barriers to Giving Feedback The Teaching Center • Our own feelings of inadequacy • Arranging time to do it • Others?

9. Receiving vs. Giving Feedback The Teaching Center • Do you recognize yourself, your teachers in any of these descriptions?

10. Receiving Feedback: Learner is: The Teaching Center • Negative/Closed • Disrespectful, closed, inactive listening, rationalizing, patronizing, superficial, denies, defensive, attacking • Positive/Open • Open, responsive, accepting, respectful, engaged, active listening, thoughtful, interested, sincere. • Think about feedback you have received and give examples of how you responded in each of these ways

11. Giving Feedback: Teacher is: The Teaching Center • Ineffective/Negative Delivery • Vague, insensitive, disrespectful, judgmental, general, poor timing, impulsive, selfish • Effective/Positive Delivery • Supportive, direct, sensitive, considerate, descriptive, specific, good timing, helpful • Give examples of both that you have experienced

12. How Do We Give Effective Feedback? The Teaching Center • Day 1 Expectations of when meet • Do it at the right time and right way • Be supportive and specific • Summarize at end and state when will occur again

13. Day 1 Clarify Expectations The Teaching Center • “Friday will be feedback day” • Then on Friday, make sure you give each person feedback or reschedule if you have to. You have made a commitment to do this. • On day 1, explain why feedback is so important to have done – this motivates learners to do their best.

14. Feedback: Formal 5-10 minutes a Week The Teaching Center • Organized in advance and predictable – not just when things go wrong. Private setting. • Start by saying: This is our feedback session. • Then ask: “How do you think things are going?” and then listen carefully. • If no response then: “What things are going well for you? Not so well?”

15. Given with Care Given with Attentive Listening Invited by Learner Specific Fully Expressed Objective Well-timed Directed toward changeable behavior Checked and clarified Evaluated Criteria for Giving Feedback The Teaching Center

16. Do not give feedback when: The Teaching Center • Learner is post-call • You are tired and/or angry at the learner • Other responsibilities conflict with the interaction

17. Do not be vague: eg don’t say: The Teaching Center • Good Job (doesn’t mean much) • You are doing great (ditto) • You did …….; you said…….; you were disorganized……you were better at the beginning of the presentation……;

18. Be as specific as you can: do say: The Teaching Center • Overall, I think things are going well, but: • I observed that….. • Could you clarify…. • It seems to me….. • In your presentation, it would have been helpful if you had….. • When would you like to meet next for a followup to this meeting?

19. Giving Positive Feedback The Teaching Center • Needs to be specific • Shows spontaneity, variety – not the same as you gave the student before this one. • Rewards specific effort that you noticed • Provides information about competence, value of accomplishments, progress

20. Unanticipated Consequences of Giving Positive Feedback The Teaching Center • Often confirms learner’s opinion of themselves. • You are considered omniscient • You get a good evaluation from the learner. One faculty member said: “I am very popular with students – I give them all honors.”

21. Giving “Constructive” Feedback The Teaching Center • If learner comes up with areas to work on: • Develop a plan of action which includes rechecking with learner in a few days • Must also include areas that are going well and emphasizing the importance of them. • Ask: “What are you going to change?” • At follow-up session, praise specific improvement: “this is much better, because..”

22. Unanticipated Consequences of “Constructive” Feedback The Teaching Center • If negative enough, learner will “ding” teacher on teacher evaluation. • Learner may not say “thank you” • Learner may not really learn much or change their ways, but some will. • Makes you feel bad – this is not why we went into teaching • What if learner doesn’t get it?

23. Conclude Feedback The Teaching Center • Summarize and give a plan of action if needed. • If problem, identify specific time to meet again in 3-4 days.

24. Our Job The Teaching Center • Give feedback that is constructive; learners will consider it either positive or negative, but our goal is to help the learner improve and grow.

25. Video of Giving Feedback The Teaching Center • Show video • Discuss: what did senior person do well? What did senior person not do well? • What did learner do well? • What did learner not do well?

26. Exercise - Groups of 3:1 learner, 1 teacher, 1 observer The Teaching Center • Example 1. Student seems uninterested, gives poor eye contact and messes with palm pilot constantly. • Example 2: Student shows up late and leaves early. He seems unhappy; has gotten only A’s so far.

27. Exercise #2 – score sheet The Teaching Center • Score Sheet: Observer to give feedback to the teacher; learner can add opinion as well. • If time for a second case, rotate roles.

28. Evaluation: Base on levels of Learning RIME:(Lewis First) The Teaching Center • Observer only (F) • Reporter only (+/- P) • Interpreter (HP) • Manager (H) • Educator: Resident Level

29. Evaluation: Grade as a Group The Teaching Center • Issues with Honors/High Pass/Pass • Combine forces with other attendings to come to group consensus! (example of how not to do it: Teach Attending/generalist).

30. Evaluation: despite our best efforts The Teaching Center

31. Summary and Conclusions The Teaching Center • Feedback should be given on each rotation • Day 1 – set expectations • Always be constructive and positive • Recognize: Not everyone will be ready to hear what you have to say.