3. Ensure patients and staff are safe
6. Achieve effective feedback - end of term interview
This page addresses Principles 3 and 6. The hypothetical videos depict the end of term interview between the supervisor and JMO featured in the orientation interview [See resource pages on 2. Promote diversity and wellbeing and 4.Monitor the work environment].
Preamble
The term supervisor endeavours to have an end of term interview with the JMO. His aims are to: thank the JMO for being a reliever in the rural hospital at short notice; notify the JMO that the term will be signed off as satisfactory; ask the JMO for feedback and provide positive and constructive feedback to the JMO on his performance during the term.
The supervisor has not worked with the JMO and sought input from other consultants. He has formed an impression that the JMO is very hardworking, shows initiative and works independently, as well as working effectively with other people however there have been a few occasions where he worked outside his role without consulting the registrar. The supervisor has been advised by the other consultants that the JMO was given immediate feedback on these occasions, which was appropriate.
In this scene, the supervisor demonstrates many effective interview strategies. In particular, he puts the JMO at ease and structures the conversation by signposting, in the opening, what will be covered, and signposting, towards the end that conversation is winding up. Here he invites the JMO to raise other issues and provides a summary. This is presented in this framework for conversations.
There are two ways in which the supervisor could have been more effective.
Firstly, knowing that the JMO would have been eager to know the outcome of the term, the supervisor could have notified him earlier that he would be signed off as satisfactory, rather than waiting for the JMO to ask (although the JMO was somewhat impatient).
Secondly, and more importantly, the supervisor's constructive negative feedback, could have been much more clear. It was too vague (possibly in an attempt to dampen any negative impact). However, it was ineffective, leaving the JMO confused and unsettled that his team and colleagues (to whom he felt a warm bond) had criticised him and without any actionable advice on how to correct his practice. Rudolph et al (2006) refer to this as debriefing without good judgement.
The feedback deals with the issue of autonomy versus consultation, which are addressed in the following charter elements:
3. Ensure patients and staff are safe
#10 Clarify when unclear or concerned about advice
#11 Practice within role and consult appropriately
4. Collaborate to create an open, safe and empowering learning environment
#13 Clarify roles, priorities and expectations, regarding communication and consultation.
#14 Show initiative, promote independence and offer support
Giving feedback and advice on these elements is often challenging. However, compared with the first scenario, the supervisor is arguably more effective on this occasion, because refers to a specific incident, as an example and respectfully explores this. Here he demonstrates the charter elements:
6. Achieve effective feedback
#22 be objective and measured in one's appraisals
#24 initiate open respectful conversation to explore poor performance, when relevant
Further, he uses that example to provide specific corrective advice that the JMO should first check with his team's registrar before making non-routine clinical decisions. This is a partial demonstration of charter element:
#25 convert feedback to effective improvement goals
Whilst the JMO was understandably confused in the first scenario, in this scenario the JMO is unnecessarily defensive of his decision to discontinue the IV fluids, focussing on clinical criteria rather than being receptive to the supervisor's main message, regarding consultation. He refutes the supervisor's advice to consult, as unworkable, rather than exploring solutions. In this sense he does not achieve charter element:
#23 be receptive to constructive feedback
Some tips for receiving feedback are shown here.
The following videos deal with the supervisor's endeavour to coach the JMO to achieve better practice.
In this scene, the supervisor calmly persists in providing corrective advice to the unreceptive JMO but may well be thinking "WTF?" Here he demonstrates respect for the JMO with charter elements:
1. Demonstrate respect
#2 interact politely and acknowledge others' effort and contribution
#4 remain composed when frustrated or stressed
However, he is not getting anywhere with this repetitive advice. Jenny Rudolph, from the Centre for Medical Simulation (Rudolph, 2006), would suggest the supervisor instead ask himself "WTF?" ie "What's The Frame?".
This is a great strategy to achieve charter elements #22 and #23
6. Achieve effective feedback
#22 be objective and measured in one's appraisals
#24 initiate open respectful conversation to explore poor performance, when relevant
This can be delivered as a three step "I" statement we suggested earlier when trying to avoid or resolve conflict (see discussion about roster in orientation video) in which you state the issue you are concerned about, why it concerns you and ask the other person more about it to understand their needs. For example, the supervisor might say:
1. You just said that consulting with your team before making decisions will impact on your autonomy
2. I am concerned that your desire for autonomy may compromise your judgment about when to consult and that this may lead to negative feedback from other teams or even harm to patients, in the future
3. How is autonomy more valuable than consultation?
On this occasion, the JMO would reveal his real need which is to make a good impression by showing he has initiative (and hence advance his career). It is only by doing this that the JMO achieves element #19
5. Monitor and manage JMOs' work environment
#19 Raise concerns (and encourage others to do the same) if any aspect of one's work impacts negatively on productivity, wellbeing, or career progression.
The supervisor will be empathetic and will be better able to motivate the JMO to change his practice, if he understands this need. This is explored in the next video.
The supervisor and JMO are communicating effectively here. The focus of the conversation has shifted from addressing the JMOs behaviours to addressing his needs. The JMO articulates these needs to the supervisor who finds a useful solution in the form of the ISBAR communication tool. This is a partial demonstration of charter element #25 - convert feedback to effective improvement goals, an example of which is demonstrated in SMART goals.
A comprehensive guide to managing formal feedback interviews is presented here.