How to Deliver Effective and Meaningful Feedback: a diagnostic checklist
“Feedback advice is something everyone knows” ...or is it? Brush up on your feedback skills –how to give and how to ask for feedback– with this diagnostic checklist.
I am on my second rotation as an intern, and it is time for mid-term feedback from our supervising consultant. I’m enjoying the unit, working diligently and often staying back late to help with patient care. I think it may even be my future dream job! My feedback is positive, highlighting my hard work. Yet, when, over coffee the next day, my co-intern and I take turns talking about our supervisor’s feedback, we quickly realise we have received, word-for-word, the same feedback. I am crushed. All that positive feedback I thought I had received now feels meaningless; it wasn’t personal or in response to my work at all and feels like it was just a tick-box exercise! This experience made me want to learn more about feedback and its use.
Feedback is the communication of evaluative or corrective information about an action or event to the original source of that action or event. In medicine, the original source is typically a medical student or junior doctor, receiving corrective information from a senior registrar or consultant. It is essential for learning in the clinical environment, with countless articles written on models of feedback, including the compliment sandwich and the Pendleton model. However, despite this and medicine’s apprenticeship model of teaching, effective feedback rarely occurs.
Whenever I start a small group-based tutorial for medical students on feedback, there is often an eye roll, and a comment that “feedback advice is something everyone knows, it’s just up to the students to generate it.” However, few students, my former student-self included, confidently understand effective feedback. It’s not surprising, as many registrars also struggle to identify what makes feedback effective and meaningful. It seems it’s a diagnostic dilemma in healthcare, where students who aren’t formally taught or modelled effective feedback principles go on to be registrars and consultants who don’t do so either. So, let’s go through the diagnostic checklist of effective feedback in clinical settings.
Who gives effective feedback?
The right diagnosis always starts with the right patient. For a learner to have relevant take-home messages for improvement, feedback must come from a credible and well-informed source. Traditionally for junior doctors, feedback comes from the head of unit completing intern feedback forms, but, just like my previous experiences, this can be ineffective as they may rarely have worked directly with you. Feedback in this setting may feel irrelevant or generic, thus head of units now source specific examples of your strengths and weaknesses from registrars and other consultants that have worked directly with you to provide specific and actionable feedback.
Feedback is task-specific
The most effective feedback starts and ends with a task or skill that you wish to develop –generic and wide-sweeping feedback on how good you are as a doctor won’t lead to improvement. The good news is that this can create multiple opportunities for a learner to receive feedback and improve their skillset. Rather than randomly asking “how do you think I am going?”, students and junior doctors can instead be directive in their feedback requests. Both the learner and the assessor need to know what task is ahead to be able to formulate useful feedback. Examples include:
- “Can you watch me lead this patient consult and give me feedback on my history-taking skills?”
- “Can you assess my indwelling urinary catheter technique and give me practical tips on improving?”
- “Can you listen to this admission plan and help me develop my management skills for this condition?”
- “Can you observe me suture this wound and help me improve my suturing technique?”
- “Can you watch me lead this team handover and teach me how to make my handover of tasks clearer?”
Feedback is time-sensitive
Feedback should occur as soon as practically possible after the task or skill has been demonstrated and assessed. This means the information is clear and relevant to the task and not clouded by recall bias. It should also occur at regular intervals, so learners have the chance to demonstrate their improvements. Feedback cannot happen in a vacuum; you need to receive it in a timely manner (not three months later!) and with sufficient time for the learner to then implement the advice and demonstrate improvement (not at the end of term assessment!).
Feedback is never personal
Feedback should never feel like a personal attack, it should never feel like someone is assessing your personality, personal values, or personal life. It should always be assessing professional skills and capabilities. You don’t have to socially connect or ‘like’ a person to provide them constructive feedback, as personal traits, opinions, and views have no place in feedback.
How to deliver negative feedback
Doctors can often be optimists who only want to give positive feedback and encouragement to junior doctors, which doesn’t necessarily help those junior doctors. Seniors can also be wary of coming across as mean or unfair when delivering negative feedback. By utilising a task-specific, time-sensitive, and non-personal system of feedback, we can pragmatically deliver tips and advice to learners. This can lead to a list of skills or actions to learn from and improve, and teachers can create another opportunity for learners to show their improvement over time. Focusing on tangible skills and tasks to improve on allows a learner to continue to develop without slashing their hopes and prevents a learner from feeling personally attacked.
As you can see, effective feedback is a two-way conversation between the learner and the assessor, so fostering a culture of learning, teamwork and psychological safety in the workplace will allow for authentic and useable feedback. Ultimately, the biggest problem with feedback in medicine is that it is poorly used and that the method for its delivery is underdiagnosed. I hope this article helps you create more opportunities for effective feedback in the clinical setting, and sparks self-reflection in learners and assessors!
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