Chapter 5Giving Effective Feedback

Faculty Development Series Madigan Army Medical Center

Tacoma, Washington 98431

Giving Effective FeedbackChapter Contents

Group Leader Check ListFaculty Learning Needs and Resources Assessment (LNRA) and Student Feedback SurveyAttendance SheetEvaluation FormEffective Feedback BackgroundPublished literature --- Giving Effective Feedback Through Dialogue with SOME TLCPlanning the Event: Example Eight Steps Example Handout Example PowerPoint Presentation Slides SOME-TLC feedback cards (separate MS Word file)

Check List for the Group Leader

Before the Session:

___ 1. Review background and literature on giving effective feedback.

___ 2. Review the example eight steps of planning for this presentation.

___ 3. Review the PowerPoint, handouts, and supporting references in this chapter.

___ 4. Duplicate and distribute the LNRA to faculty. Return at least 5 days before the session.

___ 5. Review the faculty LNRA prior to the session and integrate in presentation as needed.

___ 6. Consider performing feedback survey on department learners (Residents / Students) to

share with faculty.

___ 7. Modify the suggested eight steps, PowerPoint, and handout to fit your plan.

___ 8. Duplicate the appropriate number of copies of the attendance roster, faculty evaluation

forms, and handouts.

During the Session:

___ 9. Have each participant sign-in using the attendance roster.

___ 10. Distribute the handout(s) to the participants.

___ 11. Conduct the session based on your eight steps of planning.

After the Session:

___ 12. Collect the evaluation forms from the faculty.

___ 13. Keep the attendance roster for the session in your department and provide the

appropriate amount of CME to each participant.

___ 14. Consider performing post event survey (30-90 days) to assess eigth step (learning,

transfer, impact).

Example Learning Needs and Resource Assessment (LNRA)***Consider using internet based survey systems to design and administer your surveys (Survey Monkey for example)***

Please complete the following needs assessment for the upcoming seminar on Giving Effective Feedback as part of your faculty development program.

The seminar will consist of an introduction by your group leader, a short PowerPoint presentation, and small group discussions.

The purpose of this LNRA is to determine your learning needs and interests so that the seminar is most useful for you. This needs assessment should also stimulate you to think about active learning before the seminar begins. We need your enthusiastic participation now and during the seminar. It will be fun, and at the end of it, we'll be asking for your feedback!

Please turn this in to your group leader (______________) no later than (_____________). Your group leader will return this form to you at the beginning of the session.

1. Have you any formal training on how to give effective feedback? YES NO

2. What do you already know about giving effective feedback? Answer briefly below:

a. What are some characteristics of effective feedback?

1. 3.

2. 4.

b. What are some characteristics of an ineffective feedback?

1. 3.

2. 4.

3. In your experience, what are barriers to giving effective feedback?

4. What three things do you most want to learn or discuss regarding giving effective feedback?

a.

b.

c.

Example Resident / Student Feedback Survey***Consider using internet based survey systems to design and administer your surveys (Survey Monkey for example)***

We will be having a faculty development seminar on Giving Effective Feedback and would like your important impute to better design our seminar.

Please turn this to the faculty POC (______________) no later than (_____________). Your group leader will return this form to you at the beginning of the session.

1. How important is receiving feedback to you?

a. Very Importantb. Importantc. Moderately Importantd. Of little Importancee. Unimportant

2. In your experience, the amount of feedback you receive from faculty is:

a. Too muchb. Just rightc. Too little

3. In your experience, the quality of feedback you receive from faculty is:

a. Very goodb. Goodc. Acceptabled. Poore. Very Poor

4. Which TWO features of feedback are most important to you?

a. Specificb. Objective (not hearsay but something observed)c. Modifiable Behaviors (focus on things that can be changed)d. Expectede. Timely (Right time and right place)f. Limitedg. Constructiveh. Other:____________

5. List ways faculty can improve your feedback experience.

ATTENDANCE ROSTER – Page____of_____Pages

Department: ____________________ Institution:____________________Title of CME Activity: Faculty Development Workbook Series – Giving Effective Feedback

Course Content: Didactic and Group Discussion

Instructor (Group Leader):____________________________

Date:____________ Time: Began___________ Ended________ Total ___________

Name RankCheck One

Department or Mailing AddressStaff

PhysicianResident Physician

Other Professional Discipline

Total Number of Learners Attending This Activity: _________

Faculty Development Session Evaluation Form

Date Speaker Topic

Please rate the speaker using the scale below:

Strongly Disagree

Disagree Somewhat Agree

Agree Strongly Agree

Content was relevant to my needs

The speaker conveyed the subject matter clearly

The speaker used active learning techniques to teach this subject

The speaker gave adequate time for questions

Audiovisual / handout material added to the presentation

Overall, the speaker was effective

List one thing that you learned from this presentation:

Please add your comments/suggestion for improving this session on the back—they are VERY helpful

Faculty Development Session Evaluation Form

Date Speaker Topic

Please rate the speaker using the scale below:

Strongly Disagree

Disagree Somewhat Agree

Agree Strongly Agree

Content was relevant to my needs

The speaker conveyed the subject matter clearly

The speaker used active learning techniques to teach this subject

The speaker gave adequate time for questions

Audiovisual / handout material added to the presentation

Overall, the speaker was effective

List one thing that you learned from this presentation:

Please add your comments/suggestion for improving this session on the back—they are VERY helpful.

Giving Effective FeedbackBackground

"Human beings are purposeful organism who, if they know where they are supposed to be going, and, along the way, know whether or not they are on course, will make the

necessary adjustments.” …Unknown

The term feedback was first used by rocket engineers in the 1940's. Feedback was used to "tell" the rocket it was on course or, if off course, to guide it back onto the correct path so that it would go where it was supposed to go (i.e., reach the predetermined end point). Feedback to maintain the proper course and feedback to correct are equally important in guiding future performance.

Definition: Feedback is an objective description of performance intended to guide future

performance; the Process of letting others know your perceptions of their performance Distinct from evaluation, feedback provides information to be used to guide future

performance It is not a judgment

Review the characteristics of evaluation and feedback and think about the difference. Both are critical in assuring that your learners reach your end point and meet your standards.

Purposes of Feedback NOT to assess or judge provide information to be

used for improvement Clarify deviations from an established goal Shape behavior toward an established goal Correct inaccurate assumptions Motivate Convey an attitude of concern Learners want / need it

Characteristics of Good Feedback Measured against established standards Timely - the best feedback occurs on a day to day basis Constructive - it is intended to improve future performance and is given for no other

reason Specific - use precise and specific language Properly motivated - intended to improve future performance and not demean the

learner Directed at decision / behavior, not at the person

o Focusing on the decision allows a dispassionate dialogue with the learner

Based on personal observations and provided by anyone who is in a position to make a valid

Observation on the learner's perform performance Verified - assure the learner understood the message Followed up with a plan to monitor and assist

Giving Feedback Establish credibility / trust - this, obviously, is a long term process Prepare - take a few moments to choose the words you will use Confirm your motivation - feedback is given solely to improve future performance Start with the learner's assessment - it is easier for you and more effective for the learner Establish the "Dx" - what went well and what can be improved upon

o Gain consensus - feedback is effective if you and the learner concur on the "Dx" Determine the "Rx"

o Ask the learnero Gain consensus - future performance is more likely to improve if the learner

concurs with the plan to monitor and assist Verify that the learner understands and follow up

Giving Corrective Feedback Credibility/trust is key: Comments must be sincere The learner will be receptive if she/he feels that the feedback is given with the single

purpose of improving her/his future performance Let the learner know it's coming Ask for the learner's assessment

o It is easier for you and more effective if the learner identifies areas for improvement

Avoid traditional P-N-P sandwich --- does not promote dialogue with learner Consider using new Ask-Tell-Ask-Act sandwich discussed below. ASARP (As Soon As Resonabily Possible). Consider emotional state of learner Done in private (unless it can be given in such a manner as to not be embarrassing and is

intended to guide the future performance of the other learners present) Try not to use "YOU" or "YOUR" (this is hard to do, but it reminds us to direct the

feedback at the performance/behavior not the person) Prepare - take a few moments to choose the words you will use Set goals for future performance Follow up on the plan to monitor and assist

Summary"The goal of clinical training is expertise in the care of patients. Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all." Jack Ende

The keys are the motivation of the giver (solely to improve future performance) and the perception of the learner (that the information is provided to promote "expertise in the care of patients").

References Ende J. Feedback in Clinical Medical Education. JAMA. 250(6):777-81, 1983. Excellent,

pragmatic discussion of feedback. A superb reference. Latting, JK. Giving Corrective Feedback: A Decisional Analysis. Social Work. Sept

1992. 37(5): 424-30. Provides a useful twelve-part feedback model. Osborn LM & Whitman N. Ward Attending: The Forty Day Month. University of Utah

School of Medicine. 1991. pp 119-46. Excellent resource especially for those supervising an inpatient service.

Giving Effective Feedback Through Dialogue with SOME TLCUFP Newsletter Section Teaching and Learning, Published Winter 2011Kristian E. Sanchack, MD

Giving Effective Feedback Through Dialogue with SOME TLC

There is an awkward moment for that sometimes arises at the end of a procedure, clinic, or long inpatient day. Standing before you is the learner, perhaps a resident or medical student, with big puppy dog eyes. The eyes imply, as the student may be afraid to ask, “will you give me some feedback?” Awareness swoops in on both of you; similar to the moment a valet drops your bags in the hotel room. It is time for the tip. A list of excuses or transitions may flash through your mind’s eye allowing the blissful escape from this moment. However you know that feedback is essential. Barriers exist, but these barriers will fall way for the prepared educator.

Feedback is essential“The goal of clinical training is expertise in the care of patients. Without feedback mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved empirically or not at all.” –J. Endei

Feedback is the process of describing students’ performance for a given activity, for the purpose of improvement of their knowledge, skills and attitudes. In graduate medical education it is a key process to for the acquisition of clinical skills. Jack Ende also notes that feedback started being described in literature as system of adjustments for rocket science. This was then extended to the humanities through the study of cybernetics in the 1940s, as information relating to performance was proposed to be able to change the general manner of future performance in a process considered learning.i,ii Giving effective feedback however, does not require a degree in rocket science or cybernetics.

Feedback occurs when a learner is given insight into what the educator observed and what consequences or actions may follow. Evaluation and feedback may often be used as the same term, but this not accurate, and leads to confusion. Feedback is a formative process that should take place as a dialogue. Evaluation is summative conclusion that comes with judgment. Feedback can not only lead to greater self-awareness for the learner, but also increase the mutual understanding between a student and teacher.i,iii

Principles of Effective Feedback

“There is an art to giving feedback. If not done properly, or done with the wrong intention, the student will take your comments as criticism.” W.F. Miseri

Being aware now that feedback is essential to the education process, we must review what principles are important in giving effective feedback. Now many authors have developed acronyms to help stimulate the memory and move forward, However, I relied heavily on my peers, and was rewarded by Tien Bui, DO. Dr. Bui (who denies any use of mind expanding drugs at the time) developed the memory device of SOME TLC (See Figure 1.)iv.

Figure 1. SOME TLC

Feedback should be specific. Phrases like “good job!” in themselves do not provide any learning benefit. Instead describe precisely what was done well or not well, as well as specific areas where they can improve.

Feedback should be objective based upon your observations as the educator. Conversations on hearsay are less effective and reliable. Furthermore this allows a more neutral conversation emotionally.

Focus on modifiable behaviors, particularly those that are likely to be repeated. Through this focus you are addressing the behavior and not the person. Addressing a student concerning the fact that as you listened to their presentation, they heavily rely on notes, had difficulty finding labs values, and appeared like they had not prepared, doesn’t imply that you dislike them as a person. However if you merely tell them they are “not doing great, and need to get better” leaves them unsure as to what they should change. Over time they may feel that you are just unfair.

Feedback should be expected. Prepare the learner for feedback sessions by informing them ahead of time. For example at the beginning of the rotation, or work day let them know that you will be giving them feedback. You want to avoid the blind side hit on the learner. Consider arranging frequent scheduled feedback sessions throughout a rotation, and/or after each procedure. Increasing the frequency decreases the amount of information to be discussed, making it a faster task.

Even with scheduled sessions, feedback still needs to be timely. If something very important has occurred, it should be addressed while it is fresh in everyone’s memory. It is also appropriate to allow some extra time before addressing feedback if things are emotionally charged, or if there is significant fatigue present in either the learner or educator.

Keep your feedback limited. Covering a large range of topics is difficult and often a portion of what is discussed may be lost, however with frequent feedback moments that occur on a timely basis, you can address behaviors or performance as it happens. This allows for a small focused area to reflect on, which will allow for a more effective discussion

Finally feedback should be constructive. Your goal is to help the leaner improve, and therefore what is discusses should occur for no other reason. While certain discussions may be uncomfortable for a learner they should not walk away feeling insulted or demeanedi,iii,iv.

Dialogue Education

Consider the Johari Window (see figure 2.). A simple four square model which graphically represents, what is known and unknown to self, and others. Through a dialogue, an

S SpecificO ObjectiveM Modifiable BehaviorE ExpectedT TimelyL LimitedC Constructive

educator can describe what was observed, and discuss what the learner was or was not aware occurred. Furthermore the discussion may open up areas that could not be directly observed (student’s disclosures) and enrich the quality of training that occurs. As this dialogue occurs the public arena where learning occurs, increases in size, and the other unknown areas shrink.v

Figure 2. Johari Window

An older method of providing feedback involved the positive-negative-positive sandwich approach, however this can put off students. First they really don’t get a chance to disclose anything, as it is not a conversation. Also as it occurrs they realize a “technique” is being used so that they can be told something negative. That sandwich is not very palatable

However food is a strong visual so we can go forward with a new type of sandwich (see figure 3.), which helps you engage in a conversation. This method uses the soft sequence of Ask-Tell/Teach-Ask-Act.

Figure 3. New Feedback Sandwich

Consider starting your conversation asking them to assess their own performance. Typically you could start by asking, “How do you think that went?” It is possible you will need to probe further so consider “ What do you think went well?” or “Did you experience any problems?” This engages the learner and improves learning through praxis; a reflection on his action with intent to improve.

The learner may have already stated what was on your mind. If not now is an appropriate point in which you can describe what you observed. Simple starts are “I observed…” or “ It seemed as though…” and the classic “When you do __ I feel __” statement. It is also is appropriate point to discuss short pearls. “In my experience…” or “Consider…” For example I have had the benefit of the following sagely feedback:

“Kris when you present you sometimes talk to quickly, and people can’t keep up with what you are saying. Consider taking a deep breath before starting, and consciously try to slow down (and drink less caffeine).”

Providing some brief comments can be helpful, but the best learning occurs when the student provides the solution. Rather than asking them to repeat your comments ask “What do you think of my observations?” or “what will you do differently now?” and “What can we do to improve?”

Now that you have had a good conversation relaying good feedback using SOME TLC you are not done. The best demonstration of learning is being observed to have improved or modified the behavior appropriately. Learning is a cycle, so trust and verify that your learner understood. Hopefully you have gained the learners confidence in being open, and the learner has taken away salient points that will improve patient care.

A Tastier Sandwich

Ask

Tell / Teach

Ask

Act

With increasing restrictions on our time and our learners’ time, we need to effectively and efficiently maximize all learning opportunities. We cannot afford to be set to broadcast only. We must engage our students through active learning techniques. We have established the feedback is essential. Through SOME TLC you have the framework to apply principles of effective feedback. Using dialogue you have the ability to engage your learner in self-reflection, as well as determine information that is unavailable to you. The ultimate goal of feedback is clear communication. Now the awkward moments of silent expectation can be replaced with a mutually beneficial conversation.

Referencesi Ende J: Feedback in clinical medical education. JAMA 250(6):777-81, 1983ii Weiner N., The human use of human beings in cybernetics and society. Boston: Houghton Mifflin Co., 1950, pg 71.iii

Miser, W.F. The Family Physician as Teacher - Giving Effective Feedback.  The Ohio Family Physician. Vol. 51, no. 8: 12-13, 1999iv Luft, J. and Ingham, H. (1955) "The Johari window, a graphic model of interpersonal awareness", Proceedings of the western training laboratory in group development. Los Angeles: UCLA

Giving Effective Feedback

Example Eight Steps

The eight steps presented below may be used as a guide for your planning.Modify these steps to meet your specific needs.

Who: 20 faculty learners from the Department of Family Medicine

Why: Enhance the ability to give effective feedback as part of a required faculty development curriculum

When: 0730-0900 on a Wednesday morning, blocked schedule for faculty development

Where: Classroom, individual desks, accessible, AV supported, requires own computer and sound system. Conducive to small group activities.

What: Driven by the LNRA. Will explore characteristics of effective feedback, identify barriers, and will discuss tools and techniques that can be used to improve feedback giving skills.

What For: By the end of this session, we will have:

• Reviewed importance of feedback • Defined feedback vs. evaluation • Identified barriers to feedback • Identified ingredients of effective feedback • Applied effective feedback techniques

How: General: Active learning: small group activities and discussion, larger group discussion, minimal PowerPoint slides. Room contains individual desk. Will pre-configure desks into larger half-moon shape consisting of five or six learners. Within larger half-moon configuration, will group desks in smaller half-moon shape of two to three learners each. This will facilitate small group activities followed larger group discussions. The session will take place at 0730, so will provide coffee and bagels.

Induction Tasks: 1. This also serves as a “Grabber.” Play video containing funny feedback

moments in the movie industry. This will help learners draw from past experiences. Ask group if any of these has every happened to them.

2. Ask learners to write down two or three things that come to mind when they think of feedback. Have learners share.

3. Show result of student / resident feedback survey. Ask group to discuss results. Where there any surprises? Are our students’ expectations and beliefs in regards to feeback different then ours? Is there a feedback gap?

Input Tasks:1. Learners read brief article about giving effective feedback. Have learners

highlight reasons for giving feedback, principles of effective feedback, and ways to give effective feedback. Have learners share.

2. Feedback vs Evaluation exercise. Have learners match discriptive words with either feedback, evaluation, or both. Show slide of our own list and ask learners if they got something different an discuss.

3. Ask group to share their barriers to giving effective feedback. Then show slide of LNRA response to this question. Then ask group to share possible solutions to these barriers.

Implementation Tasks:1. Introduce SOME-TLC acronym for giving effective feedback. Have learners

in groups of two or three pick one of feedback scenarios which discribes events and obserations and have them highlist key points that they would want to sue to give feedback.

2. After introducting Ask-Tell-Ask-Act feedback techique, have learners practive giving each other feedback.

Integration Tasks:1. Review student / resident feedback survey. How will knoweldge and skills

learned today be used to narrow or decrease gap?

2. Ask group to discuss and write down what they will do for the next month to improve feedback to learners.

So What:Learning: By the end of the event, learners will have demostrated knoweldge of importance, characteristics, and skills needed to provide effective feedback. The fact that members actively participated in discussion and generation of solutions to feedback challenges and practiced giving effective feedback demostrates learning.

Transfer: This will be achieved through integration tasks noted above. The key to have each participant commit to making a change to improve how they give feedback.

Impact: Departmental feedback to learner improves with overall improved learning and education. This can be measured in a post event LNRA to faculty and to students / residents.

HandoutGiving Effective Feedback:Making a Better Sandwich

Take Home Points

• Feedback is essential • Feedback is desired by learners• Effective feedback requires preparation• Give SOME-TLC via Ask-Tell-Ask-Act

Activity #1 – Feedback Reflection – 3 minutes

Write down 1-2 words that come to mind when you think of feedback. Share these with the others at your table.

Be prepared to discuss any common themes that are present. Word #1

Word #2

Common Themes:

Activity #2 – Feedback in literature – 8 minutes

Highlight concepts of effective feedback that are important to you.

Be prepared to discuss with the group.

Giving Effective Feedback by W. Fred Miser, M.D.

The feedback we give to students should be for one primary purpose - to keep them on course so they arrive successfully at their predetermined destination (the attainment of the skills, attitudes and behaviors that will make them outstanding physicians).

Feedback is not "rocket science." It is an objective description of a student’s performance intended to guide future performance. Unlike evaluation, which judges performance, feedback is the process of helping our students assess their performance, identify areas where they are right on target and provide them with tips on what they can do in the future to improve in areas that need correcting.

Students will invariably say they do not receive enough feedback from us as teachers. Think about your own training. Did your teachers let you know what you were doing right, and what areas needed improvement? Did you receive enough feedback? Chances are your teachers let you know when you strayed off course, but did they focus on what could be done in the future so that you would not repeat the error? To be effective, feedback should consist of these characteristics:

1. Good feedback should be timely. The best feedback occurs on a daily basis, not just at the end of the rotation. If done frequently, our comments will seem less like an evaluation, and more like helpful suggestions. Take time after an encounter or procedure to provide feedback to the students.

2. Feedback is meant to be constructive. It is intended to improve future performance, and should be given for no other reason. It is not meant to demean or punish the student. Describe your observations and your own reactions.

3. The best feedback is specific. Use precise language about what specifically they did right or what they need to do to improve. Students may momentarily feel good about themselves when you say, "You did a good job." However, they will also wonder what specifically they did that earned your praise. Instead of saying, "You are clumsy," provide specific feedback such as, "The patient appeared uncomfortable when you were using the otoscope."

4. Feedback is focused on behavior, preferably ones that can be repeated, and not on the individual. Focusing on the behavior allows a dispassionate dialogue with the student.

5. Good feedback should be based on personal observations, not on hearsay.

6. Feedback should be verified. Make sure the student understood your feedback, and then follow up with a plan to monitor and assist the student in those areas that need correcting.

There is an art to giving feedback. If not done properly, or done with the wrong intention, the student will take your comments as criticism. At the beginning of the rotation ask the students how often they would like feedback, and develop a plan on providing that feedback to them. Then, before you provide feedback, take a few moments to choose the words you will use, and confirm your motivation that you are providing that feedback to improve their performance. Avoid evaluative language; its use can cause the student to respond defensively.

Feedback should be done as soon as possible, unless emotions will interfere with the session. Excellent feedback given at an inappropriate time may do more harm than good. Often after a bad outcome, students are working through their own emotions, and are often quite critical of their performance. At this time, brief feedback and emotional support are best, followed later by a more detailed feedback session. Feedback should also be done in private, unless it can be given in such a manner as to not be embarrassing. An old axiom is to "praise in public" and "critique in private."

It is often helpful to ask the students to assess their own performance. Often they will be more harsh about their performance, which then allows you to be more positive in your approach. It is

much easier and more effective for you if the students identify areas for improvement; you can then help them develop a plan of action as to how they can do things differently in the future.

When assessing performance, focus on what went well, and what can be improved. Gain consensus with the students; feedback is more effective if you and the students agree on this assessment. Some educators advocate the P-N-P (positive-negative-positive) sandwich approach to providing feedback. Begin with a positive statement, then give corrective feedback and conclude with another positive assessment. However, the positive comments must be genuine, or you will lose credibility with the student. Remember to focus on the performance and behavior, not on the person. Also, focus on those behaviors that the student can do something about. Reminders about shortcomings over which the student has no control only leads to frustration.

When determining a plan of action for improvement, ask the students what they can do. Again, gain consensus with the students; future performance is more likely to improve if they agree with the plan. It is helpful to set goals for future performance. "Next time you encounter this, try this...," then verify that the students understand, and if the opportunity arises, confirm that they did change their behavior.

In conclusion, Jack Ende has written, "The goal of clinical training is expertise in the care of patients. Without feedback, mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved empirically or not at all." (Ende J: Feedback in clinical medical education. JAMA 250(6):777-81, 1983).

We should provide feedback often to our students, helping them to stay on track so they can achieve their ultimate goal of being outstanding physicians. It is a skill that can be developed, and I encourage you to keep this foremost in your mind as you work with the students in your office.

Activity #3 – Feedback versus Evaluation– 3 minutes

Using an arrow, place the descriptive words under the appropriate heading. Some words may fall under both headings.

FEEDBACK EVALUATION

ObjectiveImmediateScheduled

InformalFormal

ObservationalDialogue

MonologueGrading

ImprovingEvent Specific

Global Performance

Activity #4 – Cases 3 minutes

In groups of 2, each person pick one scenario. Highlight items from your scenario that you would use to provide feedback keeping in mind SOME-TLC.

Case #1: (Medical resident scenario)You observe a resident performing a colposcopic exam, and biopsies. The resident was

excellent in the explanation and consent of the procedure to the patient. The patient jumps slightly during the placement of the speculum and states, “that’s

uncomfortable!” The resident repositions the speculum slightly and states “ Sometimes it is going to hurt a little”. The resident follows the appropriate sequence of actions, identifying an appropriate area to biopsy. As the resident continues with the procedure, the patient intermittently makes sounds of slight discomfort when the speculum is bumped and particularly with the biopsy.

When the resident has completed the procedure, the patient asks if she can have any medication for pain. The resident replies stating, “colposcopy is not that painful, and you should be fine with over-the-counter Motrin. Even that is not needed for most people.”

The resident concludes by stating he will call the patient with results, and he feels confident that she has only minor changes, that may not require further intervention.

Case #2: (Non medical scenario)You are teaching a class via a series of interactive workshops. Most but not all students

are there as an elective course. The curriculum requires reading between sessions. All sessions require active participation

You note that a Mary is frequently 4-5 min late for each session. She often seems to be poorly organized upon arrival. She is somewhat reluctant to be involved. Today during a group session she was texting on her phone. Another student asked her to participate or leave. She set the phone down, and returned to the activity.

When she does participate she gives insightful answers to the group. She is good at following specific directions when engaged. However this does not occur every session. You overhear a student stating, “Mary seems is either completely unaware that she is a drag on our group, or she just doesn’t care.”

Activity #5 – Giving Feedback – 10 minutes

Using the items you highlighted above, practice giving SOME-TLC using the Ask-Tell / Teach -Ask-Act model. Switch turns with your partner.

Be prepared to discuss with the group how your interaction went.

Activity #6 – Commitment to Improving Feedback – 5 minutes

Using what you have learned today and feedback needs of our students, list what you will do in the next month to improve feedback to our students.

Be prepared to share.

Example Giving Effective Feedback PPT

-Script narration available on PowerPoint Presentation

*Due to animation refer to PPT for slide clarification

*Due to animation refer to PPT for slide clarification

*Due to animation refer to PPT for slide clarification

i