GEF 1: Strategies for giving effective feedback

These strategies have been developed from selected literature on giving feedback.

Preparing for the feedback session

  1. Observe the candidate first hand.
  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 23).

Conducting the feedback session

  1. 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.
  2. Ensure relevant feedback: Align to candidate’s performance, marking criteria and clinical environment.
  3. Establish a collegial interaction.
  4. 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.
  5. 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.
  6. Observe procedural fairness: Conduct assessment in a consistent way.
  7. 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.
  8. Focus on what you’ve seen: Emphasise performance, not personal characteristics.
  9. Be honest.
  10. Encourage reflection by using open or directed questions appropriately, to encourage deeper understanding/reflection. Ask ‘why’ questions.
  11. Overcome avoidance strategies: Be assertive in your critique; stand behind your judgement.
  12. Ask the candidate to suggest strategies for change or offer options and allow candidate to select.
  13. Indicate how the desired behaviour will improve clinical practice.
  14. Develop an action plan: Encourage performance improvement.
  15. Ensure adequate documentation.
  16. Summarise at end. Check candidate’s understanding and commitment to continued improvement.
  17. 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

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

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.

Australian Medical Council 2011.

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