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The Why's and How's of Learner Feedback

I have a renewed focus on feedback - there are times when needing to give feedback are glaringly clear - and other times where it is our duty (as faculty at an academic institution). Sometimes we get too busy, too distracted, too apathetic to give our juniors the feedback they deserve. A while back, Dr. Mary Ciccarelli and Dr. Richelle Baker from IU gave an enlightening and useful seminar on feedback for learners.

Way back in 1983, Dr. Jack Ende published an awesome guideline for feedback and what happens when you don’t give it. Actually, his advice is so obvious once you read it! Probably because we over think things too much...

Dr. Ende said that if you don’t give feedback = Learners make assumptions: - Good behavior is not reinforced, so they don’t know they did a great job - Mistakes go uncorrected, so they keep making the same ones, over and over...

We need to give feedback, to everyone, for everything - because without it the good ones might go bad and the bad ones might get worse (and in medicine, they could kill someone! Ah!)

Dr. Mary Ciccarelli described this beautifully - she said we need to develop a CLIMATE FOR FEEDBACK. Basically, everyone is going to expect it and everyone is going to give it.

Avoid the old feedback sandwich - I think this can feel a bit condescending (especially if you really have nothing nice to say) and you don’t always know if they understand what you are getting at...

Instead - use the Interactive Feedback Sandwich: (Byland C, ACGME Outcome Project, NY Presbyterian)

  1. Ask: Self-assessment - of the specific situation you want to give feedback on

  2. Tell: Assess - tell them how you felt it went good/bad

  3. Ask: Reflect and plan - dig deeper if needed and then make a plan for improvement/future needs

If things really need improvement - make a SMART Plan:

  • Specific - what to work on

  • Measurable - how to identify improvement

  • Achievable/Accountable - who and how this will be measured/documented

  • Relevant - How does this relate to their job overall

  • Time Bound - when this improvement will be remeasured/remediated by

Engage the learner in this plan - so much so that they find their own solutions to the issues, instead of you giving them direction or advice. We are all high functioning adult and are quite capable of finding our own paths to growth, but you can help them by offering them opportunity to reflect and plan.

BUT this has to be a team effort, especially on the inpatient service side...

I am only on service for 1 week at a time, as are most of my colleagues. And we have different attendings covering on the weekend. Theoretically, a resident who is on our service for a four week block could work with NINE different attendings!! That might equal NINE different styles/expectations/etc - oh geez!!

So, we have to keep the “feedback ball” rolling and not only give the feedback to the juniors, but also let the next attendings know what to look out for, what areas to focus on, etc. But we should try to do this without placing too much bias - especially against the ones we think have important areas for improvement.

Therefore - Don’t start your sign over with “I’m so sorry, this team sucks!” (We’ve all probably said this or something similar it the past - I vow to never do this again!)

Instead, try to include these for each fellow/resident/med student:

  • Be specific about what the deficiency was

  • Be specific with what you tried (and how it did or did not work)

  • Aka) Focus on the areas for improvement

This is definitely a “Pay It Forward” situation, we’ve all been in their shoes and we wouldn’t be in academic medicine if we didn’t care about the learners. We need to push past the busyness of the day, the awkwardness of giving bad feedback and just do it!! Who’s with me?!!

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