Is the feedback sandwich good enough to feed your brain hole?
Listen to our medical education heroes, Dr. Abby Spencer, @abbyCCim (Cleveland Clinic), and Dr. Alia Chisty, @aliachisty (Penn State Health), school us on how to give effective and meaningful feedback! Topics include: the ADAPT framework, how to give difficult feedback, keywords and phrases when giving feedback, how to avoid gender and racial bias when giving feedback, giving feedback to your peers and how to solicit effective feedback as a team leader.
Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guests: Abby Spencer MD and Alia Chisty MD
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VCU Health CE
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.
The intent we have and the intent the learner believes we have when giving feedback is key
The ADAPT (Ask-Discuss-Ask-Plan Together) model can be used to develop shared learning goals
Be mindful of giving gendered feedback. Women and underrepresented minorities are often described by personality traits rather than by competency
Have a colleague read your letters and try to guess the gender of the trainee as a check on gender or racially biased language use
Use discussion of public perception of a learner as a means to address feedback in someone resistant or with limited insight
Consider the D’s in a learner who is struggling: Divorce, Disease, Drugs, Distraction, Depression
Start rotations by telling learners what you would like feedback on for your own performance
Ask trainees what pet peeves they have in general about rounds – probably some of them will apply to you
Feedback notes
Feedback basics
Feedback defined: (Ende, 1983) Information describing a learner’s performance in a given activity that is intended to guide their future performance in that same or an interrelated activity
Specific information about the comparison between a trainee’s observed performance and a standard given with the intent to improve that trainee’s performance
Intent we have and intent the receiver believes we have when giving feedback is key
Intent to reach the goal that the learner has set for themself
Feedback can also be thought of as the pathway to mastery (Brown 2018)
Learners are often looking for appreciation, coaching, or evaluation (Stone and Heen 2014)
Gauge what element the learner wants, and try to provide it
Barriers to feedback include time limits, the desire to be liked, and fear of hurting other people’s feelings
Honest is kind and clear is kind (Scott 2019)
Caring is providing honest and direct feedback
Someone’s inability to deliver good feedback should not interfere with your ability to take feedback
Formative feedback: Ongoing feedback that is designed to promote continued growth
Summative feedback: More formal, evaluative feedback that summarizes performance
Give feedback in a private space with sufficient time to do it properly
It can be helpful to ask your learner what their feedback should focus on prior to beginning a rotation
Feedback and bias
Females may be described in more communal terms
Women are often described by personality traits, and men by competency (Rojek et al. 2019)
Perceived positive personality characteristics are often more stereotypically masculine (e.g. “calm, decisive, confident leader”) —Mueller et al. 2017.
Behaviors can be compared against standard competencies to mitigate against potentially gendered language
It can be very helpful to have someone read your evaluation and guess the gender of the subject
Underrepresented individuals in medicine are also more likely to be described by personality traits (Rojek et al. 2019)
One study showed “competent” is a commonly used word in Black learners , compared to “standout” in white learners (Ross et al. 2017)
Advanced feedback skills
Abby Spencer’s amazing advice for providing feedback to learners who may lack insight about a deficiency: “The magic word that grants entry into the absence of insight is ‘perception’”
“I know you care, but there’s a perception among your nurses, peers, etc. …”
“How do you want the nurses to describe you?”
“You won’t get to [your] goal if the perception is X – how can we change that perception together?”
Kashlak Pearl: Consider involving human resources for professionalism concerns
Think of the D’s in the struggling learner: drugs, divorce, distraction, disease
Come from a place of curiosity, not judgement
Seeking feedback as a supervisor
Similar to asking learners about their learning goals, lead with what things you are hoping to improve on at the beginning of a rotation
One way to frame is: “Pretend your best friend is coming on service tomorrow–what can I do to make their experience better for them than I did for you?”
Ask what you should keep doing, and what you should do differently
Ask about what pet peeves your learners have experienced on rounds in general. Probably some of these apply to you!
Consider asking senior faculty to observe you on rounds
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Goal
Listeners will demonstrate effective techniques to deliver and solicit meaningful feedback.
Learning objectives
After listening to this episode listeners will…
Discuss the definitions and terms used to discuss feedback.
Deliver effective feedback that is concordant with the learning goals of their trainees.
Address potential perceived barriers to feedback.
Utilize the ADAPT framework to partner with their learners and develop shared goals.
Develop strategies to mitigate against using gender- or racially-biased narrative language.
Deliver feedback to learners with limited insight by leveraging the impact of perception on achieving goals.
Solicit effective and meaningful feedback despite being in a position of authority
Disclosures
Drs. Spencer and Chisty report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Citation
Williams PN, Spencer A, Chisty A, Brigham SK, Jyang E, Watto MF. “#233 Giving effective feedback with Abby Spencer and Alia Chisty”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date September 21, 2020.
Stone D and Heen S. 2014. Thanks for the Feedback. Penguin Books.
Scott K. 2019. Radical Candor. St. Martin’s Press.
Fainstad T et al. Feedback can be less stressful: Medical trainee perceptions of using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) framework. Cureus. 2018. [https://pubmed.ncbi.nlm.nih.gov/30906679/]
Rojek AE et al. Differences in narrative language in evaluations of medical students by gender and under-represented minority status. J Gen Int Med. 2019. [https://pubmed.ncbi.nlm.nih.gov/30993609/]
Ross, DA et al. Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations. PLoS ONE. 2017. [https://pubmed.ncbi.nlm.nih.gov/28792940/]
CME Partner
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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