Deepening SP Feedback Skills

1. Deepening SP Feedback Skills Feedback Workshop Standardized Patient Program Mercer University School of Medicine Standardized Patients General Meeting August 18, 2009

2. What is Feedback? • Dialogue • Information • Jumping off point for the learner (rather than correction) • Based on communication process rather than clinical content

3. Why is this so important? “I definitely appreciated the feedback that one of my patients gave me. I think that that was one of the best parts of the evaluation because it really gave me a feel of how I did. I do wish, however, that the other SP would have provided feedback as well. I hope that SPs are encouraged to give us feedback because it’s the most useful part.” Senior Student at Mercer

4. Characteristics of Feedback? • Specific • Based on observable behavior – what you saw or heard • An “I” statement: An objective statement of your subjective experience

5. “When you said or did ___” • I felt_________________ • I experienced_________ • I noticed I____________ • I observed I__________ • I was_________________

6. Suggestions of Giving Feedback

7. Keep the feedback in the first person.

8. Address the student as a student, and not a doctor.

9. Focus on areas of strength and areas of growth.

10. Be honest but kind in the feedback, trying to cite something positive especially when there is much negative to dwell upon.

11. Refrain from giving back the checklist; rather concentrate on behaviors like body language, voice tone, eye contact, pace or attitude, none of which will be reported to the student by any other means.

12. Students are coached before the exam, telling them this exercise is as much about process (being thorough and methodical, acting sincere and compassionate, etc.) as it is about content (achieving a high percentage from the checklist). Feedback needs to reinforce that dictum by never penalizing a student in the comment section for failing the checklist. A successful student on the series of checklist items can give a poor bedside impression. He or she should receive that feedback in the comment section. Conversely, a student may really wow you with social skills that are not reflected in the checklists. Use these comments to their advantage.

13. Use specific examples.

14. Give information as clearly and respectfully as possible.

15. Less is more!!Stay concise – one to three lines is adequate for most cases.

16. Do not compare students when you give feedback.

17. Avoid commenting on medical content.

18. Avoid using judgment terms such as “good/ bad” or “right/wrong.”

19. Some SPs contrive a list of adjectives that they find suitable to reflect positive and negative interpersonal skills, and then they draw down from this list in writing feedback. This may be helpful but should not limit your comments.

20. Check with the SP Coordinator if you are concerned about something you feel compelled to say to a student. Remember all comments are being edited by the director of the program.

21. Remember: You are there to offer information. It’s not up to your job to change anyone’s behavior.

22. SPs in Action: Comments on Feedback

23. “Student was friendly and put patient at ease. Student was eager to make patient comfortable during the physical exam. Student did a good job of reassuring patient concerning possible surgery.”

24. There is nothing I did not like about this encounter, He was relaxed, knowledgeable friendly, empathetic, and confident..”

25. He offered to talk to me about anything without telling my mom and that made me feel a little comfortable.

26. I think her plan was to give me some tough love and be relatable, but it didn’t work; she just started getting on my nerves.

27. “Made good eye contact, very pleasant smile which helps relieve anxiety. Initially she did not sound like she was going to admit me to the hospital, however, after prompting she indicated that she thought it would be a good idea for the sake of safety..”

28. “Did not mention my diet at all, did not tell me to quit drinking or smoking. Very possible heart attack, wants EKG now, may admit after reviewing results.”

29. “Lorena was impressed with this doctor’s suggestion to make bedtime less stressful and more about going to sleep. Good advice given to the patient. Student did not ask about the confusion regarding the two different shoes, although patient kept swinging her feet. The student did not ask about the falling history even though the patient was rubbing her head along the band aid line..”

30. “Very concerned, friendly, and empathetic. Great communication skills!.”

31. “When you left a silence after you asked me if there was anything else I needed to talk about, I was relieved because it gave me space to decide to tell you about my husband’s death.”

32. “When you sat and let me get upset about my dad’s death, I felt supported and listened to.”

33. “The student reassured me that it was good that I called in. That made me feel as though I was doing the right thing.”

34. “Sensed urgency from me. Non verbally acknowledged seriousness of situation. Very confident. My best yet,”

35. “Thomas Caine would return to see this doctor. He thought the doctor understood the sensitive nature of the problem not so much by what he said but by his mannerisms.”

36. Timely, constructive feedback is essential to learning. Yet too often learners don’t get the feedback they need, and some of the feedback they get is delivered too late and in hurtful ways.

37. If learners are to provide high-quality care throughout their careers, they need to value feedback and invite feedback from trusted colleagues.

38. If you help them value feedback and provide them with useful feedback, they may well begin reaching out to you and others for feedback throughout their formal education.Fostering Reflection and Providing FeedbackJane Westberg and Hilliard Jason