Feedback & Evaluation: Quick Tips for Clinical Preceptors (Part 1)

1. Feedback & Evaluation: Quick Tips for Clinical Preceptors (Part 1) Shirley Schlessinger, MD, FACP Associate Dean for Graduate Medical Education University of Mississippi Medical Center

2. “You can observe a lot just by watchin’.” Yogi Berra But things will never CHANGE if you don’t comment on what you see!

3. Why ? (You know it’s important!) • Performance does not reliably improve without evaluation and feedback • Key responsibility of the clinician-teacher faculty member • ALL of us can get better at what we do…

4. Why not? (Our lowest scores as faculty!) • I didn’t have “enough exposure” to the trainee • I don’t know what to say • Am I being fair? • I don’t want to hurt their feelings • I don’t want to hurt their career • I don’t want to be sued

5. So…Let’s get better!!! • Clearly establish expectations for learners • Understand the tools you need for evaluation (assess /measure!) • Have faith in your learners’ desire to improve! • Develop skills in targeted observation and constructive feedback

6. Feedback “Shapes” Behavior • Timely • Objective • Focused • Useful • What did the learner do well? • Where do they need to improve? • What are next steps they can take?

7. Prepare Resident for Feedback • Why feedback will be given? • “Be all that you can be…” • When will feedback be given? • Micro-feedback • Macro-feedback • Formative & Summative evaluations • How will feedback be given? Provide this info at the BEGINNING of the rotation; STICK to the PLAN!

8. MICRO Instantaneous Pure coaching Flexible format May be given in group setting May occur in response to a single observation MACRO Cumulative over time May be formative or summative Coaching & Judging Structured format (competency based) Should be a private session Micro –vs- Macro Feedback

9. Micro & Macro Feedback • More effective when initiated with self-evaluation • Should be clearly linked to expectations / goals and objectives • Should be linked to next steps • Macro-feedback should build on and reinforce microfeedback!

10. Microfeedback Template • Look for behaviors to reinforce as well as correct • Provide immediate feedback when possible • Be brief and focus on a single issue • Be specific about what you saw • Avoid speculating on intentions • Use nonjudgmental language • Encourage self-evaluation and reflection • Identify “next-time” behaviors

11. Preparing to Give Macro- Feedback • Read your residents’ notes • Consciously observe your residents interacting with families, nurses, pharmacists, social workers • Watch your resident examine patients • Probe your resident for evidence-based decision making • Consider patterns of behavior • Consider how your resident has responded to “micro-feedback” • Identify a private place to provide feedback

12. Macrofeedback Template • Ask: “What do you see as your strengths? What do you see as your weaknesses” • Tell: Summarize your observations and ideas; include both positive and negative feedback in each competency domain if possible (even the best resident can get better!!!) • Ask: “What are your next steps?”; guide resident in developing goals for growth

13. Hints for “Tell” • Focus on observations: “You did such and such…” versus “You are…” • Focus on descriptions, not judgments: “What I observed was…” versus “Your examination was inadequate because…” • Focus on specific details, not generalities: “At the start of the interview with Mrs. Jones, I noticed…” versus “Your introductions are all…”

14. DO… • Define expectations early • Get DATA (Observe, Observe, Observe) • LABEL it FEEDBACK! • Target to trainee level • Consider timing • Give feedback regularly • Ask for “self-evaluation” by trainee • Be positive when deserved • Be specific as possible • Focus on the clinically significant • Encourage trainee responsibility

15. DON’t… • Don’t be angry when giving feedback • Don’t give feedback in public or emotionally charged settings • Don’t try to cover too much • Don’t lecture • Don’t be completely negative (NEVER be demeaning…) • Don’t provide compliments only • Don’t criticize the personality (behavior!!) • Don’t ignore problems!! • Don’t wait until the end to give negative feedback • Don’t put negative comments on paper, until discussed in person

16. “Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all…”JackEnde, 1983Do not ignore problems!They will NOT go away…

17. And finally… • Fill out the WRITTEN evaluations requested by the education office in a TIMELY fashion!! • This is a measure of YOUR professionalism! • Provide written comments • Source of motivation for high performers • Road-map for improvement for others • Remembered by learner LONG after numbers are forgotten!!! • Promote personal growth