Strategies for giving effective feedback

Preparing for the feedback session

1. Observe the candidate firsthand.

2. Identify the criteria against which to performance is assessed.

3. Plan feedback content based on goals and criteria; consider amount of feedback.

4. Choose a suitable environment (privacy/setting).

5. Deliver feedback in a timely manner – as close as possible to the encounter.

6. Plan how you will deliver the feedback. Different techniques include:

• describing what went well and what needs improvement.
• using the expanded feedback sandwich (see point 23 below).

Conducting the feedback session

7. Establish consensus on expectations: Try to align the candidate’s agenda with yours; start where the candidate is at; target feedback to the candidate’s needs and readiness to change.

8. Ensure relevant feedback: Align to candidate’s performance, marking criteria and clinical environment.

9. Establish a collegial interaction.

10. Use effective communication skills such as:

• Be aware of your body language – respond with empathy; consider verbal/non-verbal behaviour.
• Use attentive listening.
• Be aware of your feelings.
• Check candidate’s understanding.

11. Ask the candidate first about their impressions of their performance and then respond. For specific components, you may ask the candidate to rate their performance as a first step. This process allows the candidate to calibrate/compare with your assessment.

12. Observe procedural fairness: Conduct assessment in a consistent way.

13. Be specific and precise: Focus on two to three points only; don’t overwhelm the candidate; clarify matters of fact; use specific examples of behaviours.

14. Focus on what you’ve seen: Emphasise performance, not personal characteristics.

15. Be honest.

16. Encourage reflection by using open or directed questions appropriately, to encourage deeper understanding/reflection. Ask ‘why’ questions.

17. Overcome avoidance strategies: Be assertive in your critique; stand behind your judgement.

18. Ask the candidate to suggest strategies for change or offer options and allow candidate to select.

19. Indicate how the desired behaviour will improve clinical practice.

20. Develop an action plan: Encourage performance improvement.

21. Ensure adequate documentation.

22. Summarise at end. Check candidate’s understanding and commitment to continued improvement.

23. Use the expanded feedback sandwich:

• ‘What do you think you did well?’ (refer to points 7, 9, 10, 11)
• ‘What do you think needs improvement?’ (The candidate is usually on target) (refer to points 10, 11, 14, 16)
• ‘This is what I saw that went well.’ (refer to points 8, 10, 12, 13, 14, 15, 17, 21)
• ‘This is what I saw that needs improvement.’ (Generally there is concurrence) (refer to points 8, 10, 12, 13, 14, 15, 17, 21)
• ‘How would you try to improve?’ (refer to points 7, 10, 16, 18)
• ‘Here are some suggestions you might try.’ (refer to points 10, 13, 17, 19, 21)
• ‘Which would you like to try first?’ (refer to points 10, 16, 18)

After the session

24. Be reflective of your approach and the strategies you used in giving feedback overall. Reflect and seek feedback on your own performance.

Giving effective feedback: Guide for individual use

Preliminary questions

• Think about situations where you have given or received effective feedback. What made it effective?
• Think about situations where the feedback was not effective – why not?
• Which WBA tools do you use?

Guide to viewing the scenarios 

Scenario 1a

This is a mid-term report interview for a PGY1 doctor.

When the question ‘What would you do now?’ appears on the screen, pause the video and consider what the issues might be and what you would do in a similar situation.

View the remainder of scenario 1a thinking about:

• What made is difficult for Dr Grades to give effective feedback
• Refer back to Strategies for Giving Effective Feedback 

Scenario 1b

As you view Scenario 1b, note on the strategies page which strategies are used.

• What did Dr Pivot do well? What strategies did she use?
• What words did she use to make the feedback more effective
• Contrast the techniques used in Scenario 1b with Scenario 1a.
• After viewing Scenarios 1a and 1b: What would you do if Marko continued to be resistant to your suggestions?

Scenario 2 – A direct observed procedural skill

• What worked well in the scenario and why?
• How would you approach the interview if Ming had failed the assessment and performed the procedure poorly?
• What strategies would be particularly important?
• What would you say to Ming immediately after observing the procedure, before you start the feedback interview?

Scenario 3 – MiniCEX

Insert YouTube video here

• What worked well in the scenario and why?
• Gat did not appear to accept the assessment made or the feedback given. How might Dr May have conducted this interview to engage Gat in the discussion more positively?

Scenario 4 – Case Based Discussion

• What worked well in the scenario and why?
• In what way is giving feedback in relation to a case-based discussion different to giving feedback in other situations?
• Why can feedback be giving during rather than after the ‘observation’?

Scenario 5 – MiniCEX

• What worked well in the scenario and why?
• What strategies were used by the assessor?
• Did the session go on too long?
• What might have been omitted?

Reflection and review

Now that you have seen the scenarios, reflect on the principles of effective feedback.

Watch the following videos on key strategies for effective feedback. Clips have been taken from the scenarios as examples for how these strategies were applied.

Which of these strategies will be of help to you when you are giving feedback?

Scenario 1b

Scenario 2

Scenario 4

Scenario 5

Reference list

Benbassat J, Baumal R. A proposal for overcoming problems in teaching interviewing skills to medical students. Adv In Health Sci Educ 2009;14:331-450.

Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008;337;1292-1294.

Chowdhury RR, Kalu G. Learning to give feedback in medical education. Royal Australian College of Obstetricians and Gynaecologists 2004;6:243-247.

DeWitt D, Carline J, Paauw D, Pangaro L. Pilot study of a ‘RIME’- based tool for giving feedback in a multi-specialty longitudinal clerkship. Med Ed 2008;42:1205-1209.

Driessen E, van Tartwijk J, Dornan T. The self critical doctor: helping students become more reflective. BMJ 2008;336:827-30.

Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ 2008;336:1129-1131.

Harden RM. Do you know? Medical Teacher 2008;30:230-231.

Hasley PB, Arnold RM. Summative evaluation on the hospital wards. What do faculty say to learners? Adv in Health Sci Educ 2009;14:431-439.

Hrisos S, Illing JC, Burford BC. Portfolio learning for foundation doctors: early feedback on its use in the clinical workplace. Med Ed 2008;42:214-223.

Irby DM, Wilkerson L. Teaching when time is limited. BMJ 2008;336:384-387.

Ker J, Cantillon P, Ambrose L. Teaching on a ward. BMJ 2009;338:770-772.

Kneebone R, Bello F, Nestel D, Mooney N, Codling A, Yadollahi F, Tierney T, Wilcockson D, Darzi A. Learner-centred feedback using remote assessment of clinical procedures. Medical Teacher 2008;30:795-801.

Milan FB, Parish SJ, Reichgott MJ. A Model for Educational Feedback Based on Clinical Communication Skills Strategies: Beyond the ‘Feedback Sandwich’. Teaching and Learning in Medicine 2006;18(1):42-47.

Sargeant JM, Mann KV, van der Vleuten CP, Metsemakers JF. Reflection: a link between receiving and using assessment feedback. Adv. In Health Sci Educ 2009;14:399-410.

Steinert Y. The ‘problem’ junior: whose problem is it? BMJ 2008;336:150-153.

Tan R, Brett SJ, Stokes T. Rehabilitation after critical illness: summary of NICE guidance. BMJ 2009;338:b822:767-768.

van der Ridder JMM, Stokking KM, McGaghi WC, ten Cate OTJ. What is feedback in clinical education? Med Ed 2008;42:189-197

Veloski, J, Boex JR, Grasberger J, Evans A, Wolfson DB. Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Medical Teacher 2006;2:117-128.