Delivering Effective Feedback

1. Delivering Effective Feedback A Faculty Development Program for Teachers of International Medical Graduates

2. Workshop Objectives At the end of this workshop, participants will: • Describe some of the common issues in providing feedback to IMGs • Outline the qualities of effective feedback • Practice delivering feedback according to sound educational principles • Better understand the perspectives of IMG learners

3. Feedback vs. Evaluation • Feedback: on-going provision of information about performance, to guide and improve future efforts • Evaluation: a judgment about previous performance

4. Everyone Seeks Feedback… • And if we don’t get it, we make assumptions and attributions! • Self-assessment is notoriously unreliable • Without feedback, learners may extinguish desirable behaviours and entrench undesirable ones • Alas, medical teachers don’t deliver as much feedback as they think…

5. Are IMGs Different? • NO • And YES

6. What Have Been Your Experiences Delivering Feedback to IMGs? • In what ways has it been similar to working with Canadian graduates? • In what ways has it differed? • What are the barriers, what are the enablers, for you in your setting?

7. How IMGs May Be Different… • Tremendous cultural diversity • Critique may be viewed as serious error • Power dynamics may be different • Difficulty in exposing weakness • Consequences of failure • Older than other learners • Family circumstances and financial burdens • Adjustment to new culture and language

8. An IMG’s Story “An example of a cultural issue I faced during my family medicine rotation was to meet, and examine a transgendered patient - previously a male, now a female. When my supervisor introduced the issue to me, I couldn’t imagine myself seeing the patient, or even talking to her. I felt this was an awkward and uncomfortable situation, which I had never experienced before. I even asked my supervisor frankly not to see this patient.” Anonymous, 2004

9. As a Teacher, What Would You Do? • “I can’t do it” • What do you think is happening with the learner? • How could you use feedback to help her?

10. Commonly Reported Issues • Medical knowledge • Clinical skills • Communication skills • Language skills • But these are HIGHLY variable between individuals!

11. Think of Times When You, as a Learner, Have Received Feedback… • When it was helpful – what was it that made it so? • When it was not useful – why was that?

12. Steps in Delivering Feedback Build an environment of trust and support • Role-model by asking for, and using, feedback • Role-model an acceptance of personal gaps in knowledge and skill • Convey an awareness that mistakes are inevitable • Actively encourage asking for advice/help

13. Steps in Delivering Feedback Plan ahead and negotiate • Feedback shouldn’t come as a surprise • Clarify the difference between feedback (coaching) and an evaluation (judgment) • Seek out opportunities to observe (more on this later)

14. Steps in Delivering Feedback Elicit learner self-assessment • Helps in understanding learner’s thinking • Can determine the most useful points for feedback • Helps in gauging the appropriate level of sophistication • Often the learner will do most of the work! • But some IMGs are unfamiliar, or reluctant

15. Steps in Delivering Feedback Choose appropriate timing and setting • As close in time as possible • Quickie feedback followed by later discussion if necessary • Privacy may be necessary • Emotions may need to settle

16. Steps in Delivering Feedback Focus on the positive, not just the negative • Teachers tend to be quicker to correct than to reinforce • Change is more likely if positive feelings are engendered • Frame message in positive terms • Indicate impact of behaviour

17. Steps in Delivering Feedback Select specific, changeable behaviours • Tendency to give TOO many learning points – pick 2 or 3 • Describe observations – be specific • Pick those that the IMG can CHANGE! • Focus on previously identified learning needs

18. Steps in Delivering Feedback Use a feedback model (sandwich or grid) • Systematic approaches are helpful • PNP sandwich (highlight a positive aspect, then one to be improved, then another positive) • Feedback grid adapted from the Bayer Institute (behaviours to continue, or do more of; behaviours to start doing; behaviour to stop or do less of; future behaviours)

19. Feedback Grid

20. Steps in Delivering Feedback Include follow-up plans • New behaviours need reinforcement • Implementation is not easy • Include strategies for putting it into practice • Follow-up helps reinforce change • AND highlights successes

21. In Summary… • Build an environment of trust • Plan ahead and negotiate • Elicit self-assessment • Determine appropriate setting and timing • Focus on the positive • Select specific changeable behaviours • Use a feedback model • Include follow-up plans

22. Observing Learners.. What Are Your Opportunities and Strategies? In the same room: • Keep quiet • Avoid eye contact with the patient • Turn to the learner if addressed by the patient Use natural opportunities: • Listen to phone conversations • Hallway discussions Briefly observe many different parts of encounters

23. Practice Makes Perfect!