Giving feedback
Tools of the Trade21st November
University of Leicester
Dr Adrian Hastings and Dr Rhona Knight
• ‘Feedback or knowledge of results, is the lifeblood of learning.’
Rowntree D (1982) Educational Technology in Curriculum
Development(2e). Paul Chapman Publishing, London.
• Giving feedback constructively valued by junior and senior doctors
Wall D and McAleer S (1999) Teaching the consultant teachers -
identifying the core content. Medical education 33.
What will we cover?
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
Why bother with feedback?
• It works:– improves learning outcomes
– better marks in assessments– better results in other learning situations
– deepens approach to learning– encourages active pursuit of understanding
and application of knowledge• Black P and Wiliam D (1998) Assessment and classroom teaching. Assessment in Education
5:7-73.• Rolfe I and McPherson J (1995) Formative assessment: How am I doing? Lancet 385:837-9.
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
What is it?
• ‘A two-way process in which an educational supervisor or group appropriately share with the learner information based on observation, with the aim of reaching a defined goal.’
• Knight R. The Good Consultation Guide for Nurses, Radcliffe 2006.
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
In three groups• Task 1
– Each share a time when you received feedback that was helpful
– As a group draw together some key themes of helpful feedback
• Task 2– Each share a time when you received feedback
that was harmful– As a group draw together some key themes of
harmful feedback• Task 3
– Identify a list of key features of effective feedback
Two dimensions to feedback
Challenge
Support
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
“Good, carry on,seems to be
working”
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
In passingNothing
UnspecificDismissive
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
“That was great, you’re
obviously trying hard”
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
PatronisingGeneral
Safe
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
“Well that could have been done better – why did you not focus more, early on..?”
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
CriticalInduces defensivenessParalysing
Two dimensions to feedback
High Challenge
High support
Low support
Low Challenge
“A good effort.I could see how youwere drawing the feelings out – Iwonder if you got to the crux of the matter…?”
High Challenge
High support
Low support
Low Challenge
FocusedAttentive
Threatening?
Two dimensions to feedback
Types of feedback
• Brief feedback
• Formal feedback
• Major feedback
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
A selection of tools
• Tool 1: Pendleton’s ‘Rules’
• Tool 2: Calgary - Cambridge
• Tool 3: Non-judgemental feedback
• Tool 4: Observation versus deduction
• Tool 5: Pi
• Tool 6: PEE
• Tool 7: Unacceptable behaviour
1. Pendelton’s ‘rules’
1. Pendleton’s ‘Rules’(Pendleton D, Schofield T, Tate P, Havelock P. The New Consultation.
Oxford University, 2004.)
• The learner goes first and performs the activity• Questions then allowed only on points of clarification
of fact• The learner then says what they thought was done
well• The teacher then says what they thought was done
well• The learner then says what was not done so well,
and could be improved upon• The teacher then says what was not done so well
and suggests ways for improvements, with discussion in a helpful and constructive manner
2. ‘Calgary – Cambridge’
SET-GO (Silverman et al.)
• What I Saw
• What Else did you see?
• What does the learner Think?
• What Goal are we trying to achieve?
• Any Offers on how we should get there?
ALOBA(Silverman et al.)
• Agenda
• Led
• Outcome
• Based
• Analysis
3. Non-judgemental feedback
Non-judgemental feedback
– Based on description
– ‘Communication skills are neither intrinsically good nor bad, they are just helpful, or not helpful, in achieving a particular objective in a given situation’
– Silverman et al.
Descriptive non-judgmental feedback
• Aim: to support the learner and maximise learning
What is it?• Evaluative/judgemental
– The beginning was awful, you just seemed to ignore her.
– The beginning was excellent - great stuff!!
• Descriptive
– At the beginning you were looking at the notes, which prevented eye contact.
– At the beginning you gave her your full attention and never lost eye contact – your facial expression registered your interest in what she was saying.
4. Observation vs deduction
Observation versus deduction
– Separate behaviour and interpretation– Make interpretations tentative
– I noticed at this stage that you moved more in your seat, and your face became red, I wondered if you might be embarrassed?
I saw you look at your watch and thought you might be bored
I saw him talking with his hand over his mouth and wondered if he was lying
• Behaviour
Arms foldedLegs crossedFlushed cheeksRapid voice tempoSlow steady breathingTight lips
• Interpretation
BoredGood rapportEmbarrassedAmusedDisgusted
5. Pi () – Point / Illustration
Pi () – Point / Illustration
– Make sure that the student knows what you’re talking about!
– As well as a label, give an example
Point
Illustration
Point / Illustration
• Point
I’d like you to use more open questions at the beginning of the consultation.
• Illustration
“Why not ask the patient at the beginning ‘How can I help?’”
6. PEE – point / explanation / example
5. PEE – point / explanation / example
– I’d like you to clarify more what the patient said. (Point)
– Clarification is about checking you understand what the patient means. The patient’s understanding is not always the same as yours. (Explanation)
– If the patient says she is worried something might be serious, you could clarify what she means by serious. (Example)
• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities
In groups
• In what situations would you use each of these tools for feedback?
A selection of tools
• Tool 1: Pendleton’s ‘Rules’
• Tool 2: Calgary - Cambridge
• Tool 3: Non-judgemental feedback
• Tool 4: Observation versus deduction
• Tool 5: Pi
• Tool 6: PEE
A final tool…
6. Unacceptable behaviour(eight top tips)
• 1. Check person is OK before you start
• 2. Use a wake-up, warning phrase:“There’s something very serious I have to say”
• 3. Say, very simply, what is not right
• 4. Give an example as appropriate
• 5. Relax the tone to allow for a positive response
• usually an offer to improve ensues
• 6. Respond to offer positively • but define specific, measurable outcomes
• 7. Do not be drawn into discussion on: – justification of behaviour – your right to judge
• 8. Separate behaviour and person
– Most of us take criticism better if it is not personal.
• “Maybe what I did was not good – but it doesn’t mean I’m no good.”
• Make sure that the student can see this distinction too.
In twos
• One of you is a ‘junior colleague’
• One of you is the tutor– Identify an area of bad behaviour you
have had to deal with– Share it with your partner– It is the job of the tutor to address the
bad behaviour described
Summary...
TEAM Feedback Guidelines
• Timing
• Environment
• Appropriate
• Manageable
Appropriate feedback is:
– Suited to purpose– Specific– Directed towards behaviour
rather than personality– Checked with the recipient– Problem solving– A suggestion rather than
prescriptive
Useful further reading:• Teaching made easy
• Chambers and Wall• Radcliffe 2000• ISBN: 1-85775-373-9
• Teaching and learning communication skills in medicine• Kurtz, Silverman and Draper• Radcliffe 1998• ISBN: 1-85775-272-2
• Adult and continuing education• Jarvis• Routledge 1995• ISBN: 0-415-10242-1
• The Good Consultation Guide for Nurses • Hastings and Redsell (eds)• Radcliffe 2006• ISBN: 1-85775-688-6