6. Achieve effective feed
This page focuses on feedback provided in the workplace. The resource page 3. Ensure patients and staff are safe also addresses feedback in the context of the mid or end of term interview.
Four versions 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.
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.
Let's watch the videos
Example 1 - Teacher-centred (Tell) - ineffective constructive criticism
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.
In example 1, the supervisor launches into an analysis of the JMO's performance without first asking the JMO to self appraise. 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 does not ask the JMO about the possible factors contributing to poor performance nor are learning goals addressed. The supervisor's tone of voice and body language are neutral, consequently she does not impart positive regard for the JMO.
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.
Key learning point
Ideally, supervisors would "Ask - Tell - Ask"
Ask for self appraisal in the first instance, followed by
Tell the learner what (the supervisor) observed regarding reinforcement of good performance and areas requiring correction
Ask the learner about factors affecting their performance and potential corrective strategies
Ask-tell-ask is further explained in this short video.
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.
Summary of charter elements featured
#2 interact politely and acknowledge others' effort and contribution
#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