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Giving feedback. Tools of the Trade 21 st November University of Leicester Dr Adrian Hastings and Dr Rhona Knight.

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Giving feedback

Tools of the Trade

21st 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.


Why bother with feedback?

What is feedback?

Key features of feedback

General principles of feedback

A feedback toolbox

Consider the practicalities

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?

  • 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

Support

Challenge


Two dimensions to feedback

High support

High Challenge

Low Challenge

Low support


Two dimensions to feedback

High support

High Challenge

Low Challenge

“Good, carry on,

seems to be

working”

Low support


Two dimensions to feedback

High support

High Challenge

Low Challenge

In passing

Nothing

Unspecific

Dismissive

Low support


Two dimensions to feedback

High support

“That was

great, you’re

obviously

trying hard”

High Challenge

Low Challenge

Low support


Two dimensions to feedback

High support

Patronising

General

Safe

High Challenge

Low Challenge

Low support


Two dimensions to feedback

High support

High Challenge

Low Challenge

“Well that could

have been

done better – why

did you not

focus more,

early on..?”

Low support


Two dimensions to feedback

High support

High Challenge

Low Challenge

Critical

Induces

defensiveness

Paralysing

Low support


Two dimensions to feedback

High support

“A good effort.

I could see how you

were drawing the

feelings out – I

wonder if you

got to the crux of

the matter…?”

High Challenge

Low Challenge

Low support


Two dimensions to feedback

High support

Focused

Attentive

Threatening?

High Challenge

Low Challenge

Low support


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’


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?

SET GO


ALOBA(Silverman et al.)

  • Agenda

  • Led

  • Outcome

  • Based

  • Analysis

ALOBA


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


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.

What is it?


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 andwondered if he was lying


Behaviour

Arms folded

Legs crossed

Flushed cheeks

Rapid voice tempo

Slow steady breathing

Tight lips

Interpretation

Bored

Good rapport

Embarrassed

Amused

Disgusted


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

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?’”

Point / Illustration


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...


    Timing

    Environment

    Appropriate

    Manageable

    TEAM Feedback Guidelines

    TEAM


    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


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