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Feedback. Transition day 2013. 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.
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Feedback Transition day 2013
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.
“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
Expert/Master Proficient Ability Competent Advanced Beginner Novice Dreyfus SE, 1980
In theory there is no difference between theory and practice... -Yogi Berra
In practice, there is. -Yogi Berra
Expert, Elite Performer Cognitive NOVICE Miller GE. Academic Med. 1990.
Expert, Elite Performer Skills NOVICE Miller GE. Academic Med. 1990.
EXPERT Clerkships/Residency NOVICE
Expert/Master Instructor Manager Proficient Ability Interpreter Competent Reporter Advanced Beginner Observer Novice Dreyfus SE, 1980
Expertise/ Ability Low Stakes High
Elite Performance Repetition Self-reflection Motivation Endurance
Elite Performance Deliberate practice Work on well-defined tasks Informative feedback
The acquisition of superior performance in medicine is closely related to engagement in practice with feedback during medical training.” -Ericcson, Academic Med 2004
...This type of learning is not possible without the students’ full cooperation and active participation in the learning process. -Ericcson
If you don’t know where you’re going, you might end up someplace else. -Yogi Berra
Patient care: Information Management-recording & presenting Data Gathered from History and Physical Exam • Presentations smooth, • organized, contribute to • efficient rounds. • Able to discern important • details while staying concise. • Presentations disorganized. • Difficulty discerning amount • of detail needed.
You can learn a lot by watching -Yogi Berra
Johari Window You Know Not Know Others Public Self Blind Spots Known Not Known Private Self Unknown Luft & Ingram, 1961
Johari Window You Know Not Know Others Public Self Blind Spots Known Not Known Feedback Private Self Unknown Luft & Ingram, 1961
If I’ve told you once I’ve told you a thousand times! It’s “i” before “e” except after “c”!
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?
For example, The case of Millie Kablunschki
Was this feedback? Is it effective? “A sensory or perceptual report of the result of any behavior which may reinforce or modify subsequent behavior. “
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 resident said: 1. Student did not focus on the patient first 2. Student did not give pertinent findings 3. Student was reminded that vitals are pertinent 4. Student was reminded CXR cannot make a dx 5. Student was informed about consequences
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
Do we recognize feedback? It may seem personal, but it isn’t… Our dress, behavior, speech, habits all affect how we perform as professionals Tone of voice, email composi- tion, facial expression, can sometimes overshadow the message - tune in to the message
Effective feedback should 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. Timely • Ask: “Any advice you would give me about this writeup?” 3. Professional – Respectful in voice, words, timing, location • We are future colleagues 4. 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.” 5. A plan for improvement • Focus on the next step in learning, improved performance, how to make our work/patient care better
We do not require constant feedback • Good students provide themselves feedback. • We should not need to be told to arrive on time, dress appropriately, or be polite • We should all be able to accurately self assess some of our work • Students who lack self awareness also lack awareness of others - like their patients… • No one can assess your self assessment • But we can observe its results
What to know about giving feedback Students also give feedback It needs to be: • Objective, timely, professional, explanatory, and 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
What to know about feedback - Skill development depends on receiving practical and timely feedback based on direct observation - We can influence quantity and quality of feedback we get - Take initiative - Invest in it from the beginning - Identify, set and share learning goals - Create opportunities for practice with observation - Plan times for feedback - Pick up on the positive - Tune in and respond to the feedback given
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 Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger - Franklin P. Jones
Excuse me for interrupting, but it’s “i” before “e” except after “c.” (Weird isn’t it?)
