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6. Achieve effective feedback 1- procedural skills

 

Charter elements featured

Demonstrate respect

#2   interact politely and acknowledge others' effort and contribution

Promote wellbeing

#5   show concern for others

Achieve effective feedback

#20 believe you are valued, show positive regard and acknowledge good performance in others

#21 encourage self-appraisal and reflection

#22 be objective and measured in one's appraisals

#23 be receptive to constructive feedback

#24 initiate open respectful conversation to explore poor performance, when relevant

#25 convert feedback to effective improvement goals

Three videos of a hypothetical supervision situation are shown. The scene shows a supervisor providing feedback to a JMO following insertion of an intravenous cannula in a patient. 

The videos demonstrate how the supervisor's perspective influences feedback on procedural skills.

 

  • Firstly, in respect to whether the supervisor asks for self appraisal by the learner versus telling the learner how (the supervisor) feels they performed.

  • Secondly, how much emphasis is placed on positive reinforcement of good performance versus correction of poor performance. 

  • Thirdly, the extent to which the supervisor, in the first instance, asks the learner about possible reasons for poor performance and potential corrective solutions versus telling the learner how to make corrections.

Ideally, supervisors would Ask Tell Ask

  1. Ask for self appraisal in the first instance, followed by 

  2. Tell the learner what (the supervisor) observed regarding reinforcement of good performance and areas requiring correction

  3. Ask the learner about factors affecting their performance and potential corrective strategies

 

However, what is right in any situation depends upon context, for instance, what training and feedback sessions have previously occurred, how much time is available and how the 'teaching' impacts upon clinical service. Even if the feedback is brief with minimal 'asking', other elements of the 7 principles will impact its effectiveness. These are shown in the videos.

Let's watch the videos

 

Background. If you have time and are interested, you can view the 3 minute video showing the JMO inserting the IV cannula. The JMO performed most aspects of the procedure well. The supervisor wishes to provide constructive criticism on two aspects. Firstly, the JMO was overly focussed on the technical aspects of the procedure and neglected to observe and respond to the patient's discomfort. Secondly, the JMO failed to correctly dispose of the sharp. 

Example 1 - Teacher-centred (Tell) -  ineffective constructive criticism

In example 1, the supervisor focuses specifically on task elements not performed well and requiring correction. There is no  reinforcement of good performance for specific task elements, or for the JMO's overall performance. The supervisor's tone of voice and body language are neutral. Learning goals are not addressed.

 

Example 2 - Teacher-centred (Tell) -  effective constructive criticism

 

 

In example 2, the supervisor again focuses specifically on task elements not performed well and requiring correction however, she places these in context of multiple other appraisals (where presumably reinforcement of good performance has occurred) and reinforces that overall the JMO is performing well. In addition, she first checks how the JMO is feeling (as this shapes the supervisor's approach) and, rather than using neutral body language, she is consciously positive in her demeanour. 

Again, in the interests of time, the supervisor is 'teacher-centred' by telling the JMO several correctional strategies.

 

The JMO also demonstrates that she is receptive to feedback by indicating she is aware of reasons for the performance deficits. She demonstrates respect by acknowledging and thanking the supervisor for the feedback.

 

Focusing on negative (correctional) feedback can work as long as it is placed in context and positive reinforcement also occurs. 

Example 3 - Teacher-centred (Tell) - positive reinforcement plus constructive criticism

This is another example of teacher-centred feedback, in which the supervisor directs the conversation, delivering her appraisal plus correctional strategies. However, in the first instance, the supervisor focuses on positive reinforcement of good performance before addressing deficits. As in example 2, correctional strategies are offered and the JMO demonstrates that she is receptive to feedback and acknowledges and thanks the supervisor for the feedback.

Example 4 - Learner-centred (Ask - tell - ask) - focus on learner self appraisal and reflection)

 

 

 

 

 

 

 

 

 

 

 

 

 

In this final example, the supervisor enables the JMO to be more active in the feedback conversation, both in appraising her performance and suggesting strategies for improvement of deficits. This is an adaptation of Pendleton's rules of feedback. As in previous examples,  the video demonstrates how feedback is most effective when respect and concern for other's wellbeing are evident.

 

 

 

Promote wellbeing: The supervisor and JMO are friendly toward each other. The supervisor pre-empts the JMO's anxiety by using a calming tone of voice and body language and prompting her 'not to rush, take a breath ......"

 

Charter element demonstrated

#5 show concern for others

 

Demonstrate respect: The nurse and supervisor's body language and facial expressions are supportive and non-threatening. Their language is  polite. Everyone remains composed and focussed on success with the next attempt.

 

Charter elements demonstrated

#2 interact politely and acknowledge others' effort and contribution

#3 respect reputations

#4 remain composed when frustrated or stressed

Ensure patients and staff are safe: Everyone addresses the patient in a reassuring way. The nurse observes the situation and suggests that the specialist doctor might be available to assist. The JMO responds by accepting her suggestion to involve the supervisor

Charter elements demonstrated

#11 practice within role and consult appropriately

#12 communicate our concerns and listen to concerns raised by patients and colleagues.