CPD for CBME The Binnendyk Feedback Game James

CPD for CBME “The Binnendyk Feedback Game” James Ross, MD, MHPE, FRCPC

Overview • CBME session with psychiatry consultants re: feedback • The feedback game • Challenges with engaging consultants in discussions around CBME

CBME session with consultants • Organized with psychiatry CPD to discuss feedback with psychiatry consultants • Poor feedback that has limited value an ongoing issue • Consultants only invited to increase frank discussion • Session based heavily on Schulich CBME workshop several months prior • Involvement of colleagues (mainly junior) as co-presenters

Objectives for Workshop By the end of the session participants should be able to: 1. Describe key elements of effective written and oral feedback about clinical psychiatry skills 2. Formulate clinical feedback for learners in psychiatry that is clear and useful

Overview of Workshop • 15 minutes - Introduction and brief presentation • 15 -20 minutes – Discussion of barriers to delivering feedback to learners in psychiatry and strategies to overcome them “Why don’t we give more feedback? ” • 20 minutes - case scenario #1 • 40 minutes – Feedback language exercise (board game) incl debrief re: effective words/language • 20 minutes – Case scenario #2 • 20 minutes – wrap-up discussion

Good written or verbal feedback • Task-oriented • Specific • Actionable

Feedback Language Board Game • Each group has a collection of feedback quotes, mostly from psychiatry • Categorize each feedback into helpful or not helpful • If helpful, identify if feedback meets markers of “Task-oriented”, “Specific” or “Actionable”. • If not clearly helpful, categorize as “unhelpful” and write on cue card how you might re-word the feedback (using some artistic license re: resident activity). • We will discuss alternative responses and language after the game

Examples of feedback written for game • You did a good job explaining the diagnosis in detail using DSM V criteria. Evidence based pharmacological treatment options were discussed. You continued providing information about the diagnosis missing on the emotional cues from the patient, who was distressed. I would recommend taking a pause and allowing time for the patient to express their feelings and address any questions that patient may have. • You did a great job at explaining the diagnosis and treatment options. Practicing more of such interviews and continued reading will be beneficial. Keep it up!

Examples of feedback written for game • Dr. Kandel has an advanced knowledge of neuropsychiatry and psychopharmacology. His clinical skills are coming along but he had difficulty connecting with patients and getting all of the required information in some interviews. He could improve his information gathering and treatment plans by getting the full story from the patient and putting symptoms into more of a context. Readings about interview techniques, such as Shea could be helpful. • Dr. Beck did very well with anxiety and depression cases but seemed to struggle while treating other presentations. Keep seeing complex patients and keep reading around cases.

Feedback language: discussion • Did doing the game bring up any new ideas about how to give feedback? • What would you would start doing differently based on the game? • What language did you use for the new feedback? • Are there specific words or phrases that you found useful?

Challenges • Whether feedback was “good” or “bad” was fairly obvious, in spite of attempts to throw in some red herrings • Discussion about what could be better about feedback was generally productive but… • Sometimes bogged down in semantics – e. g. “task-oriented” vs. “specific” • There still seemed to be skepticism as to why CBME could be helpful for learning.

Questions/Discussion