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Overview

Providing regular feedback to the trainee regarding his/her work with you is the most powerful teaching tool a faculty has. It is also the area most commonly cited as lacking when trainees evaluate medical faculty. Quite simply, feedback is the sharing of information about the trainee's performance. Positive feedback serves to sustain behavior that is appropriate and effective. Negative or corrective feedback serves to change behavior that is inappropriate or ineffective. Thus, the trainee should receive a mixture of positive and corrective feedback. The feedback should be specific enough that the trainee understands which behaviors are appropriate and which ones need to be changed. General comments such as "you're doing a really super job!" may be pleasant to give, but do little in the way of teaching. Feedback is most meaningful when it is based on solid data obtained while observing or interacting with the trainee. This teaching skill becomes easier with deliberate practice. An experienced faculty who has worked on developing this skill can incorporate feedback comfortably and quickly into regular interactions with a trainee.

Definition

Feedback is giving specific information about a trainee's current behavior in order to help him/her either continue the behavior or modify the behavior.

Purposes

• Provides a basis for maintaining or improving performance.
• Provides a forum for assessing needs and planning additional experiences.

Timing and Setting

• Most useful immediately following the experience.
• Process established during orientation.
• Brief, en-route encounters.

Characteristics of Effective Feedback

• It is specific and performance based.
• It is descriptive, not labeling.
• It focuses on the behavior, not the trainee.
• It is based on observations, repeated if possible.
• It begins with "I" statements.
• It balances negative and positive comments.
• It is well timed.
• It is anchored to common goals (for example, the trainee’s learning or quality patient care).
• It provides for two-way communication, soliciting, and considering the receiver’s input.
• It is brief. (Be alert to signs of resistance).
• It is based on trust, honesty, and concern.
• It is private, particularly if it is negative.
• It is part of your regular teaching process, not an exception to the norm.
• It provides for follow-up.

Guidelines for Providing Constructive Feedback

• All comments should be based upon observable behavior and not assumed motives or intents.
• Positive comments should be made first in order to give the trainee confidence and gain his/her attention.
• Language should be descriptive of specific behaviors rather than general comments indicating value judgments.
• Feedback should emphasize the sharing of information. There should be opportunities for both parties to contribute.
• Feedback should not be so detailed and broad. It should not "overload" the trainee.
• Feedback should deal with the behaviors the trainee can control and change.
• Feedback requires the ability to tolerate a feeling of discomfort.

SFED Feedback Model

Feedback and Coaching - "SFED" Ask Tell Ask

Self Assessment "Ask" The Learner...

• "How do you think that went?"
• "What was effective?"
• "What do you think you would like to do differently?"

Allow the learner to speak first, use reflection to encourage a "deeper dive", balance positive and negative comments to focus on improvement.

Feedback/Facts - "Tell" The Learner

• Provide non-judgmental, timely, feedback on specific behaviors and skills.

Encouragement - "Respond" to The Learner

• Convey confidence to the learner.
• Use a supportive tone.
• Use empathy skills: reflection, legitimization and exploration.

Direction - "Ask" The Learner to Self Identify Strategies

• "Where am I?"
• "Where do I need to be?"

Challenge the learner to reach their potential, collaborate on next steps, "How do I get there?"

Find a quiet, private space for feedback, name what you are doing: "I'd like to give you some feedback. Is now a good time?"

ARCH Feedback Model

A - Ask/Allow for Self-Assessment

Ask the learner to self-assess what they did well and what they could work on. Example: "How do you feel about your interview with Mr. Smith? What do you think went well? What do you think you could continue to improve on?"

R - Reinforce Things Done Well (KSA)

Reinforce what is done well (attitudes, skills, and knowledge). Example: "I agree that you were able tot take a thorough history and that it was well-organized."

C - Confirm Areas Needing Correction

Confirm what needs correction or improvement. Example: "Although you were thorough in your review of systems, it appeared to me that Mr. Smith really wanted to talk more about his joint pain. Did you notice that as well?"

H - Help Learner with Improvement Plan 

Help the learner with a plan of improvement, and coach as needed. Example: "Why don't you write up our discussion today with goals to work toward this week and email it to me? I'll make time this week to make sure we discuss your progress toward achieving those goals."