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The trainee in difficulty: Breaking the bad news PowerPoint PPT Presentation


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The trainee in difficulty: Breaking the bad news. Dr Val Bythell Programme director Northern Schools/ Northern Deanerty. Whose ‘bad’ is it anyway?. Yours Others The trainee’s. All feedback is ‘good’.

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The trainee in difficulty: Breaking the bad news

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The trainee in difficulty breaking the bad news l.jpg

The trainee in difficulty:Breaking the bad news

Dr Val Bythell

Programme director

Northern Schools/

Northern Deanerty


Whose bad is it anyway l.jpg

Whose ‘bad’ is it anyway?

  • Yours

  • Others

  • The trainee’s...


All feedback is good l.jpg

All feedback is ‘good’

  • Feedback that is thought / intended to be ‘good’ may not be perceived as such by the trainee if poorly given

  • Negative feedback may bring out into the open longstanding difficulties that the trainee is aware of and wants help with

  • ‘Feedback is the breakfast of champions’


Why is the trainee in difficulty l.jpg

Why is the trainee in difficulty?

Trainees don’t want to perform poorly….

  • Sickness

  • Social circumstances

  • Inadequate training

  • Lacking ability


Inadequate training l.jpg

Inadequate training

Not intentional..

  • Failure of timely feedback is extremely common


What inhibits feedback l.jpg

What inhibits feedback?

  • Failure to observe

  • Fear of- emotional response

    - reduction of teacher’s popularity

    - harm to student’s self-image

    Often justified as ‘the circumstances aren’t appropriate’, ‘I don’t have time’ or ‘its not my job’


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Consequences of inadequate feedback

  • Trainee is ‘adrift’, without direction

  • More susceptible to negative body language

  • May develop false standards, arrogance

  • May develop paralysis, fear

  • Becomes dependent on summative feedback, exams

  • Loses opportunity to improve (eg moves to another post)


What type of information do you have l.jpg

What type of information do you have?

  • Hearsay / gossip

  • Direct report - verbal,written

  • Directly observed performance

  • Concrete outcome data

  • Sickness / absence data

  • Trainee’s self-reported difficulties


What do you need to do l.jpg

What do you need to do?

  • Consider risk management / patient safety issues

  • Obtain as much specific information about the perceived difficulties, and about perceived good behaviour, as possible

  • Arrange a feedback / appraisal meeting with the trainee ASAP - appropriate setting etc


Effective feedback do s l.jpg

Effective feedback - ‘Do’s’

  • Prepare

  • Maintain respect, empathy

  • Begin with open questions

  • Listen

  • Limit feedback to remediable behaviour

  • Be specific about both ‘good’ and ‘bad’ behaviour

  • Check understanding


Remediable behaviour vs inferred l.jpg

Remediable behaviour vs. inferred...

‘You are often late for lists’ is better than

‘Your time-keeping is poor’

‘I have some difficulty in understanding what you are saying’ is better than

‘You don’t communicate well’


Possible causes of frequently being late l.jpg

Possible causes of frequently being late...

  • Not adequately informed re. time to attend

  • long/difficult journey

  • caring for dependents

  • illness - eg drug dependency, depression

  • awareness that things are going badly

  • etc etc


Giving feedback l.jpg

Giving feedback

  • Ask the trainee to tell you how things are going first

    What is going well with your training?

    What aspects could you improve?


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Effective feedback - ‘Don’ts’

  • Don’t use indirect / inferred statements

  • Don’t let fear prevent you from giving negative feedback

  • Don’t be generally supportive then specifically critical

  • Don’t discuss innate characteristics or attitudes, only actions


Receiving feedback l.jpg

Receiving feedback

  • Listen

  • Check understanding

  • Try not to be defensive

  • Thank the giver for the feedback


If the feedback is not skillfully given received l.jpg

If the feedback is not skillfully given & received...

  • Defensive behaviour - ‘shoot the messenger’,

  • Blames others and circumstances

  • Basic message is not heard


If feedback is successfully given l.jpg

If feedback is successfully given...

Together with the trainee (and others)

  • Formulate goals/objectives

  • Decide on how best to achieve those goals


In summary l.jpg

In summary

Don’t avoid giving ‘negative’ feedback

Always give specific positive feedback first

Comment on behaviour, not core characteristics

It will not be as bad as you think it will!


Thank you l.jpg

Thank you

Feedback in clinical medical education. J Ende

JAMA 1983;250:777-781

http://www.ncl.ac.uk/nsa


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