Many people think that feedback is inherently negative, and that is not true. Feedback is a purposeful instruction to improve a performance-led behavior, and if we use it in that context, it is truly a valuable teaching technique.
—Charlene M. Dewey, MD, MEd, FACP
Providing students and residents with feedback on their medical performance is a key element in their learning and development and ensures that high standards are met, according to Charlene M. Dewey, MD, MEd, FACP, Assistant Dean of Educator Development; Associate Professor of Medical Education and Administration; and Associate Professor of Medicine at Vanderbilt University School of Medicine in Nashville. Without effective feedback, mistakes go unchecked, good performance is not reinforced, and students and residents will not develop the high-competency skills necessary for quality patient care or the ability to build positive working relationships with their colleagues, added Dr. Dewey.
The ASCO Post talked with Dr. Dewey about the importance of providing effective feedback to medical students, residents, and other trainees; when to give feedback; and how to prepare for giving feedback.
A Two-Way Street
Why is giving professional feedback to students and other trainees important?
There are several main reasons. Effectively communicating what is expected of the learner sets the groundwork for professional responsibilities, medical knowledge, and good communication skills. It also enhances the professional relationship between the teacher and the learner. Teachers should feel safe in giving feedback, and learners should feel safe in receiving it. And the conversation should be a two-way street: The teacher gives feedback to the learner, and the learner gives feedback to the teacher.
Feedback also serves as a window into our own behaviors and helps prevent conflicts. The clearer you are in the information you are giving, the greater the understanding will be.
There used to be a lot of assumptions that somehow if trainees just observed what their supervisors were doing, they would be able to absorb that knowledge. Now we know that observation alone is not enough, which is why the process of feedback is so critical to trainees’ success.
A Valuable Teaching Technique
Should feedback be given at a scheduled formal meeting or during daily rounds?
Both. I believe that every teaching moment is an opportunity to provide feedback, and if we are not giving feedback during every teaching opportunity, something will be missed. Many people think that feedback is inherently negative, and that is not true. Feedback is a purposeful instruction to improve a performance-led behavior, and if we use it in that context, it is truly a valuable teaching technique.
Also, feedback should be given in both oral and written forms. If a performance needs immediate attention, feedback should be given right away. If there is something sensitive about the observation that was made, it is best to wait until a private meeting can be held. There are two types of feedback evaluations: formative, in which the teacher is giving continuous feedback about how well the learner is doing overall; and summative, which is an assessment of the learner’s overall skills that is given at the end of a rotation.
As I go through rotations with residents, I am constantly giving them feedback. Halfway through the rotation, I might sit down with a resident and ask how he or she is doing and give my observations on the areas the person has improved on and what areas still need work before the end of the rotation. Then, at the end of the rotation, I have a final discussion with residents and give them a written evaluation, which is a compilation of all the feedback I’ve given them throughout the rotation period.
Core Competency Areas
What areas are covered during the formal meeting?
I tend to cover the six core competency areas every physician needs to become proficient in proposed by the Accreditation Council for Graduate Medical Education (ACGME; acgme.org). They include medical knowledge, patient care, professionalism, interpersonal communication, practice-based learning and improvement, and systems-based practice.
Observe and Listen
How can supervisors prepare for giving effective evaluations to students and residents?
The most important quality is being a good observer and a good listener. If you are matching what you are personally observing in the student’s performance with the gold standard of the six ACGME core competencies, you will give appropriate feedback, so those are my first two tips.
The third rule I follow is the 5-step reflection and feedback plan I developed. The plan includes the following steps: observe and assess first—elicit the learner’s reflection; identify the feedback focus—teacher and learner; reinforce positive behaviors; discuss changes and improvements; and summarize and create an improvement plan.
Supervisors should communicate their evaluations concisely and clearly and not beat around the bush (see sidebar "Giving Effective Feedback"). ■
Disclosure: Dr. Dewey reported no potential conflicts of interest.
Education in Oncology focuses on faculty development, medical education curricula, fellowship training, and communication skills. The column is guest edited by Leora Horn, MD, MSc, Associate Professor of Medicine, Assistant Director of the Educator Development Program, and Clinical Director of the Thoracic Oncology Program at Vanderbilt University School of Medicine, Nashville.
Charlene M. Dewey, MD, MEd, FACP, Assistant Dean of Educator Development; Associate Professor of Medical Education and Administration; and Associate Professor of Medicine at Vanderbilt University School of Medicine in Nashville, offers these suggestions for effectively communicating feedback to...