Session 3

Session 3 - Creating feedback climate

Giving inclusive feedback

https://www.td.org/atd-blog/first-do-no-harm-how-to-build-leaders-who-give-inclusive-feedback 

Inclusive feedback.pptx

Negative capability: how to embrace intellectual uncertainty 

‘when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason’

John Keats


https://nesslabs.com/negative-capability

Applying negative capability to being a medical educator


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

§  Check in again with student on their response to feedback, take home messages etc.

 

Examples

§  Phrased in as non-evaluative language as possible

§  Specific not generalised

§  Focussed on behaviour not personality

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…’

 

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


Metaphors: What metaphor connects with your lived experience of giving or receiving feedback?


1. Transformation:

2. Resource: 

3. Control: 

4. Connection: 

5. Container:  

6. Journey: 

7. Balance 


Connection: given feedback connects with others. 

Transformation: feedback can transform the learner. 

Resource: feedback is a resource your share with others. 

Journey: Feedback is like a journey you go through the learner (related to a conversation journey) 


Louise and RA had a discussion  after the session   

Balance: feedback is a way of balancing out the learning. It helps you to reveal hidden areas where deep transformative learning may occur. Negative capability can support this space. 


fb.pptx

Positive feedback experiences – prize nominations

Giving helpful feedback

She also gave us all helpful feedback to help us improve for the future.

 

She was very upfront about assessing our history taking and examination skills, and gave us feedback which allowed us to improve these throughout the course of the week.

 

She encouraged professional behaviors and provided us with excellent feedback on how to improve our reflections.

 

She has also actively encouraged everyone to participate in discussions and provides rich feedback to our reflective writing

 

He gave us plenty opportunity to clerk patients in his clinics, giving constructive feedback and trusting our clinical judgement which really helped with my confidence.

 

Moreover, she supervised us running clinics in the morning and then gave us feedback on that as well.   One of the most approachable and friendly doctors I've met.

 

There was a constant feedback loop regarding students' strengths and weaknesses regarding various topics and clinical skills. He would often go out his way to ensure everybody reached the same level of competency.

 

She takes great joy in observing our history taking and information giving skills and has provided us with excellent feedback on how to improve.

 

Gave advice and constructive feedback on how to present findings and how to evaluate clinical findings.

 

He also gave us regular feedback on our history taking skills, which I found very valuable as I noted his comments down and aimed to improve them in future situations.

 

He was always available to discuss difficult cases and feedback on how we felt after difficult consultations He really made sure that we were included as part of the practice staff and was one of the main reasons my final year GP placement was the best placement that I had as a student

 

She always provides comprehensive critical feedback on what we have done well and what we could improve.

 

Dr. X gave us lots of great feedback after every session, she made sure we were always involved and learning and she made us reflect on everything and all of it really improved our knowledge and skills.

 

He has given us so much feedback over the year about our knowledge development and professional development.

 

He gave us feedback on our history taking and examination skills, and he even organised a mock osce for us on our last day! He did all this while making sure we were having a good time, which made for a really productive and enjoyable placement.

 

She also provided a great deal of helpful feedback on our progression and work throughout the year, and I felt very well supported by her as a tutor.

 

She also took the time to provide feedback and provide suggestions for us to improve

 

Gave me really useful personalised feedback.

 

Very friendly, supportive, happy to make time for us, offers useful feedback. Really helped improve my confidence with GP surgery consultations.

 

She also give constructive feedback after every patient that students saw in clinic allowing them to improve clinical skills. Very good teaching style. Struck the right balance between giving me independence and support.

 

 

Requesting feedback

Furthermore, she has given us many opportunities to feedback on our experiences so that she can tailor future sessions to our needs

 

They arranged specific teaching, home visits, a day with a  podiatrist and on a renal replacement unit and constantly asked for feedback which they acted on.

 

He was interested and went out of his way to make it an enjoyable experience. He listened to our feedback and made us more aware of the social factors and the environment- factors which may affect the patients. He was really kind, friendly and approachable and made us feel welcome in the practice.

 

Really appreciated the amount of effort she put into organising our sessions, in lots of ways - organising patients for us to speak to, seeking feedback on constructive ways to do things as well as reading up on cases and information prior to the session.

 

 

Negative feedback experiences – from negative log/student complaints

I felt that he is not a suitable doctor for medical students to sit in with/see patients with. Additionally, on multiple occasions he chose to deliver feedback to us in front of patients that felt like we were being berated. On one occasion a patient's parent in the room even spoke up saying that we were still students learning in an attempt to change Dr X’s approach.

 

Not only was this examination shared with another student, we received no useful feedback from the GP despite specifically requesting for such.

Asking questions

He asks questions that make us consider the patient in a holistic manner, and models professional behaviours in his patient interactions that I would absolutely aspire towards myself. He treats all patients, and us, with respect, and has fantastic relationships with all the patients we've met.

 


Student feedback scenarios -home grown

 

Practise feedback

Scenario 1

Jenny/John is a 3rd year student who has taken a history of a patient with intermittent abdominal pain and bloating and carried out an examination of her GI system. In her/his history taking they are (as one might expect in year 3) asking quite a lot of general questions, there are quite a few closed questions also, possibly too early on in the consultation. You wonder if there may have been ongoing social or emotional issues in terms of life stress as the patient gave a few cues that life is a bit difficult at the moment. This dimension of the history was not really explored. The history taking is fairly well structured for a year 3 student but does jump about a little between presenting complaint and past history.

The examination started well with good communication with the patient. The student did observe the patient from the end of the bed but did not fully expose the abdomen and was sometimes looking down at their hands rather than observing the patient facial expression and missed the patient wincing once. In general the examination was fine but the student came across as underconfident. Their summarising of the history and examination was also a bit hesitant and could be developed by having a clearer structure.

 

 

Scenario 2

GP tutor

Susan/Sam is a 5th year student who has been on placement for 5 weeks. Time for final feedback. There have been issues all the way along through this placement, where she/he have been turning up late, missing some clinics without prior notice. There has been some issue of sickness but not clearly communicated in advance. Susan/Sam is a very capable student and has a great deal of medical knowledge and their clinical skills in general are up to speed, however their approach to patients and colleagues is not always as respectful as one would desire. You are not sure if this is just their attitude in general practice as they have made it clear that they do not want to be a GP, or whether this is a broader ranging issue. Susan/Sam seem blissfully unaware that there might be any issues so far. You have tried to talk to them mid placement but you were in a rush and the conversation had not been as fruitful as you hoped. You are going to pass the student on this placement but feel there are some more attitudinal issues that might need to be addressed.

 

 

 


Email

Dear all,

Look forward to seeing you next week for session 3 online (but **NB we are planning hopefully for session 4, 8th Feb, for in person).

 

We are exploring giving feedback and how we might think about being inclusive in our feedback.

We will also bring in the theme of negative capability. https://nesslabs.com/negative-capability

 

Please find attached a paper by Cantillon, prof of primary care in Ireland on feedback – I really like this paper.

Also a 6 minute read on negative capability.

 

Reflection:

 

Please be reflecting on feedback you have given and received. The feedback culture created. How you create a good and safe feedback space for students.

 

Queen Mary University of London ranks top of the Russell Group in the English Social Mobility Index 2022 (Higher Education Policy Institute, HEPI) being regarded as the most inclusive and diverse Russell Group university. What does being inclusive mean for offering feedback to students?

 

Questions we will think about:

· How might we offer inclusive feedback?

· What are the barriers to offering constructive feedback?

· What areas do we need to focus on when seeking to be developmental and inclusive (e.g. power dynamics, questioning assumptions, awareness of systems and context)