Giving feedback
Giving and receiving feedback
Without feedback, good practice is not reinforced, poor performance is not corrected, and the path to improvement not identified...Feedback is about providing information to students with the intention of narrowing the gap between actual and desired performance...1
Why feedback to students?
Feedback is a high priority as it contributes greatly to student learning. Your feedback, especially as a respected role-model, has the potential to help students develop academically, clinically, reflectively and in their professional behaviour.
What is the purpose of giving feedback?
Feedback to students can fulfil 2 roles, affirming them and encouraging further development.
Affirmative - Encourage and motivate students in their learning and development towards becoming a doctor
Developmental - Constructively speak into weaker areas in a way that offers suggestions of how they might do better. This needs to be done carefully so that it is not demotivating.
What is good feedback?
Providing constructive feedback is not an easy task. Teachers may fear damaging the student-teacher relationship or undermining the learner’s self esteem.1 Receiving feedback, especially being open to developmental feedback can also be challenging to the student. So the effectiveness of an exchange of feedback may be enhanced through development of both feedback giver and receiver. FB 2 way…role model culture
One paper reveals how students are not good at recognising good feedback. They preferred to receive general compliments than constructive criticism. However, development in ability to tie surgical knots was improved more by constructive criticism than praise. The authors conclude:
‘Student satisfaction is not an accurate measure of the quality of feedback. It appears that satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.’2
Another paper finds that students are not good at self-evaluation, researched through asking students to estimate exam results in tests of logic and grammar. The best students felt they had done worse than the reality and the worst students better than they actually had. After showing the students examples of marked papers the top quartile of students rated themselves more accurately whereas the bottom quartile of students remained blissfully unaware. The authors’ conclusion was that poor performers don’t know what a good performance looks like and that self assessment is poor in areas that we are poor.3
In summary, students like to be praised and although this may not develop learning, it may encourage and motivate them. Students also need help in recognising their weaker areas.
Tips on giving verbal feedback
Giving feedback
Establish the student’s agenda
Start positive
Be descriptive, specific, non-judgmental
Use of silence
Check understanding
Responding to cues
Direct feedback at behaviour that can be changed
Offer your observations (not assumptions or personal comments)
Offer ideas rather than advice
Examples
Phrased in as non-evaluative language as possible
Poor: ‘Your history taking was poor…’
Good: ‘I noticed that you did not make eye contact with the patient…’
‘I noticed that you interrupted the patient several times…’
Specific not generalised
Poor: ‘You seem to have a problem establishing rapport with your patient…’
Good: ‘I noticed that you do not greet your patients at the start of the consultation….’
Focussed on behaviour not personality
Poor: ‘You are very paternalistic with your patients….’
Good: ‘I noticed that you chose the treatment option for your patient….’
Suggestions
· Start off asking the student ‘How do you think you are doing?’.
· For a student who is reluctant to accept criticism ‘How do you think the patient felt about your....’
· … ‘I wonder if you had tried’
· … ‘maybe you could have…’
For more info
References
1. Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008;337.
2. Boehler ML, Rogers DA, Schwind CJ, Mayforth R, Quin J, Williams RG, Dunnington G. An investigation of medical student reactions to feedback: a randomised controlled trial. Medical Education. 2006; 40 (8): 746-749.
3. Kruger J, Dunning D. Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence lead to Inflated Self-Assessments. Journal of Personality and Social Psychology. 1999; 77 (6): 1121-1134