Giving feedback

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Giving feedback

• Tools of the Trade
• 21st November
• University of Leicester
• Dr Adrian Hastings and Dr Rhona Knight

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• 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.

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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

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• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities

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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
  57-73.
• Rolfe I and McPherson J (1995) Formative
  assessment How am I doing? Lancet 385837-9.

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• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities

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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.

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• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities

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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

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Two dimensions to feedback
Support
Challenge
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Two dimensions to feedback
High support
High Challenge
Low Challenge
Low support
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Two dimensions to feedback
High support
High Challenge
Low Challenge
Good, carry on, seems to be working
Low support
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Two dimensions to feedback
High support
High Challenge
Low Challenge
In passing Nothing Unspecific Dismissive
Low support
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Two dimensions to feedback
High support
That was great, youre obviously trying hard
High Challenge
Low Challenge
Low support
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Two dimensions to feedback
High support
Patronising General Safe
High Challenge
Low Challenge
Low support
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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
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Two dimensions to feedback
High support
High Challenge
Low Challenge
Critical Induces defensiveness Paralysing
Low support
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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
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Two dimensions to feedback
High support
Focused Attentive Threatening?
High Challenge
Low Challenge
Low support
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Types of feedback

• Brief feedback
• Formal feedback
• Major feedback

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• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities

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A selection of tools

• Tool 1 Pendletons 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

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1. Pendeltons rules
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Pendletons 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

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2. Calgary Cambridge
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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
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ALOBA(Silverman et al.)

• Agenda
• Led
• Outcome
• Based
• Analysis

ALOBA
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3. Non-judgemental feedback
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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.

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Descriptive non-judgmental feedback

• Aim to support the learner and maximise learning

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What is it?

• 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.

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4. Observation vs deduction
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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?

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• I saw you look at your watch and thought you
  might be bored
• I saw him talking with his hand over his mouth
  and wondered if he was lying

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• Interpretation
• Bored
• Good rapport
• Embarrassed
• Amused
• Disgusted

• Behaviour
• Arms folded
• Legs crossed
• Flushed cheeks
• Rapid voice tempo
• Slow steady breathing
• Tight lips

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5. Pi (?) Point / Illustration
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Pi (?) Point / Illustration

• Make sure that the student knows what youre
  talking about!
• As well as a label, give an example
• Point
• Illustration

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Point / Illustration

• Point
• Id 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?

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6. PEE point / explanation / example
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5. PEE point / explanation / example

• Id like you to clarify more what the patient
  said. (Point)
• Clarification is about checking you understand
  what the patient means. The patients
  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)

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• Why bother with feedback?
• What is feedback?
• Key features of feedback
• General principles of feedback
• A feedback toolbox
• Consider the practicalities

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In groups

• In what situations would you use each of these
  tools for feedback?

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A selection of tools

• Tool 1 Pendletons Rules
• Tool 2 Calgary - Cambridge
• Tool 3 Non-judgemental feedback
• Tool 4 Observation versus deduction
• Tool 5 Pi
• Tool 6 PEE

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A final tool
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6. Unacceptable behaviour(eight top tips)

• 1. Check person is OK before you start
• 2. Use a wake-up, warning phrase
• Theres something very serious I have to say
• 3. Say, very simply, what is not right
• 4. Give an example as appropriate

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• 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

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• 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 doesnt
  mean Im no good.
• Make sure that the student can see this
  distinction too.

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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

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Summary...
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TEAM Feedback Guidelines

• Timing
• Environment
• Appropriate
• Manageable

TEAM
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• Appropriate feedback is
• Suited to purpose
• Specific
• Directed towards behaviour rather than
  personality
• Checked with the recipient
• Problem solving
• A suggestion rather than prescriptive

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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