Evaluation and Feedback

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Evaluation and Feedback

• Christina Surawicz, MD, MACG
• University of Washington School of Medicine
• With thanks to Dr. Eileen Klein and the UW
  teaching scholars 2005-06

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Learning Objectives

1. Understand the importance of feedback
2. Learn techniques for giving feedback
3. Lean how to receive feedback

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Definition of Evaluation

• Measure of knowledge and/or skills
• Also called
• Assessment
• Appraisal
• Compared to
• Peers
• Absolute standards

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Feedback vs Evaluation

• Evaluation
• Scheduled
• Summative
• Formal
• Judgment based on comparison to peers or norms
• Example middle or end of rotation

• Feedback
• Brief
• Formative
• Nonjudgmental, specific, and descriptive
• Focus on behaviors learner can modify
• Example right after clinical presentation

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Evaluation of Fellows - Parameters

• Cognitive
• Procedures
• Communication
• Professionalism

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How to Measure Professionalism

• 1. 360 evaluation - labor intensive
• 2. Two questions on evaluation
• This individual treated me with respect
• Scale of 1 - 5
• This individual treated others with respect
• Scale of 1 - 5

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Coaching and Feedback

• Feedback is a term coined by the
• flight engineers to describe a
• directional system that provides
• information to a rocket about its
• course and causes it to correct

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Why is Feedback Important for Trainees?for
Trainer?
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Why Feedback is Important - Trainee

• Opportunity to improve
• Insight into their behavior
• Allows them to reach goals

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Why Feedback is Important - Trainer

• Demonstrates interest and caring
• Allows one to see progress
• You are doing the right thing (personal
  fulfillment)

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• Providing feedback strongly correlated with
  students perceptions of effective teaching
• (Elnicki Cooper, JGIM 2005)

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Important for the Profession

• Competent physicians
• Correct mistakes
• Underscores importance of feedback
• Underscores necessity for self-evaluation

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Without Feedback Silence

• Assume approval no news is good news
• Assume disapproval they probably all think I am
  hopeless

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4 Generations Practicing Now

• Born
• Traditionalists 1922 1945
• Boomers 1946 1964
• Generation X 1965 1979
• Generation Y (Millennials) 1980 - 1994

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Boomers

• Workaholic
• Service oriented
• Optimistic
• Personal gratification
• Technology
• Nice
• Not necessary

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Millennials

• Current trainees
• Culturally diverse
• Technology necessary
• Civic-minded

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Giving and Receiving Feedback - Boomers

• Give
• Once a year with documentation
• Receives
• I want to know how Im doing

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Giving and Receiving Feedback Generation X

• Give
• Here it is now and its honest
• Receives
• I want to know now and often

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Giving and Receiving Feedback - Millennials

• Give
• Ill explain if somethings wrong
• Receives
• Whenever I want it, at the push
• of a button

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Giving Feedback to Trainees

• Set up the expectation for feedback
• Be more concerned about the learner than yourself
  (Boomers)
• Feedback should have meaning (Millennials)

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What are Barriers to Feedback?
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Barriers to Feedback

• Not enough time
• Not worth it- doesnt work anyway
• Prior negative experience
• Unclear expectations
• Effect on teacher-learner relationship
• Lack of training!!!

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Feedback - Three Strategies

• Pendletons Rules
• SETGO
• Ask - Tell Ask Act/Follow up

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Pendletons Rules

1. What did you do well today?
2. What I think you did well
3. What could you do differently next time?
4. What I think you could do differently next time

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Feedback Techniques SET GO

• What I SAW (Describe what you saw)
• What ELSE did you see? (What happened next)
• What do you THINK? (Learner reflection)
• What GOALS are we trying to achieve?
• OFFER suggestions on how to achieve goals.
• Chowdhury, R. Learning to Give Feedback in
  Medical Education. The Obstetrician and
  Gynecologist, 2004 6243-7

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Ask Tell - Ask

• Ask How are things going?
• Be specific How did rounds go today?
• Tell I observed
• Be specific
• Ask how can you improve?
• Act/Follow up

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Feedback Basics Dos

• Clarify situation
• Describe behavior
• Deliver impact

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Useful Questions

• What are your goals?
• How do you think its going?
• What has gone well so far?
• What could be improved?
• What will you do next time?
• What changes can you make?

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Useful Phrases

• When you said . . . I was concerned because. . .
• This is my suggestion . . .
• Lets reframe this issue . . .
• Lets reflect about what happened . . .
• Lets talk about this when the time and location
  may be more appropriate.
• Suggest a time/place or ask the learner to pick a
  time and place
• We all want whats best for the patient

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Feedback Donts

• Be vague
• Be judgmental
• You always. . .
• Accuse
• Psychoanalyze

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Role Play Faculty or Attendees?
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Lets Practice - Case 1

• It is a busy day on consult service, you have one
  fellow seeing consults. On rounds, the
  presentations are disorganized, incomplete, for
  example, an evaluation of a patient with rectal
  bleeding does not mention patient has abnormal
  LFTs.

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When? Where?

• When to evaluate?
• On rounds?
• After rounds?
• Next day?
• Where to evaluate?
• Outside patients room?
• Team room?
• Empty endoscopy room?

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Ask

• How do you think rounds went today?

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Tell

• You seemed unprepared to present the patients
  thoroughly for example, the presentation on
  patient x did not mention her abnormal liver
  tests.

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Ask

• Is there anything that can help you see and
  evaluate these complex patients more efficiently?

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Act/Follow Up

• Some suggestions for evaluation- ask the fellow
  to provide them!
• Lets follow-up in 2 days

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Case 2

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Attending Perspective

• You have been on service for a couple days and
  you are not pleased with the fellow you are
  working with. Their presentations lack detail
  and you are worried they are not getting enough
  history to implement adequate plans. You also do
  not believe the consult notes are not clear
  enough.
• You make a list of areas in which the fellow can
  improve and give it to the fellow.

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Trainee Perspective

• This is the first time you have been on service
  with this attending. They are very compulsive
  and seem to be involved in every detail of care.
  You are very thorough in your history taking and
  speak at length in person to the team about your
  recommendations of care for the patients you
  consult.
• You believe the list of areas in need of
  improvement is not accurate.

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What are the issues and how can they be remedied?
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Issues

• Expectations not set up ahead of time
• Do not fully understand each others perspective
• Feedback not requested/permitted
• Feedback not in person
• Solutions identified by attending without
  eliciting information from fellow and before
  discussion

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Case 3
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Fellow Perspective

• Another busy day on service and you are running
  to your next consult. On your way you have been
  stopped in the hall four times by residents to
  answer quick questions about their patients.
  You politely do so in every case and are able to
  finish all of your work before afternoon rounds.
  You are proud of your thoroughness, efficiency
  and professionalism.

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Attending Perspective

• Just prior to afternoon rounds you hear about
  advice given regarding the care of a patient with
  recurrent C. difficile colitis. No formal
  consult was done and you are frustrated that the
  fellow would give advice on this case without a
  formal consult.
• You mention this to the fellow on rounds and are
  surprised they are not more receptive to you.

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Optimizing Feedback

• Pick the time and place
• Non-judgmental
• Attending
• Ask the fellow their perspective
• Ask the fellow to come up with solutions
• Fellow
• Ask to give your perspective
• Offer solutions

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Tips for Receiving Feedback

• Negative feedback is hard to take when given by
  a friend, relative or stranger
• Anonymous
• But remember that
• Change is not possible without some element
• of conflict

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Receiving Feedback

• If you are a leader, you may need to ask for it
  especially form juniors
• How to ask?
• 31
• 3 things I am doing well
• 1 thing I can improve

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Receiving Feedback

• Being open/approachable
• Listen
• Body language
• Responding
• Reflect
• Donts
• Argue
• Defend
• Give excuses
• Reply? Later!!
• Thank them for giving feedback

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Questions?
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Summary

• Know the elements of evaluation for trainees
• Understand the importance of feedback
• Learn techniques for giving feedback
• Lean how to receive feedback

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To Dos at Home

• Commit to giving feedback regularly and often
• Commit to asking for feedback -
• what can I do better?
• You will be a great role model