Delivering Effective Feedback A Faculty Development Program for

Delivering Effective Feedback A Faculty Development Program for Teachers of International Medical Graduates

Workshop Objectives At the end of this workshop, participants will: ● ● ● Describe some of the common issues in providing feedback to IMGs Outline the qualities of effective feedback Practice delivering feedback according to sound educational principles Better understand the perspectives of IMG learners

Feedback vs. Evaluation ● ● Feedback: on-going provision of information about performance, to guide and improve future efforts Evaluation: a judgment about previous performance

Everyone Seeks Feedback… ● ● And if we don’t get it, we make assumptions and attributions! Self-assessment is notoriously unreliable Without feedback, learners may extinguish desirable behaviours and entrench undesirable ones Alas, medical teachers don’t deliver as much feedback as they think…

Are IMGs Different? ● NO ● And YES

What Have Been Your Experiences Delivering Feedback to IMGs? ● ● ● In what ways has it been similar to working with Canadian graduates? In what ways has it differed? What are the barriers, what are the enablers, for you in your setting?

How IMGs May Be Different… ● Tremendous cultural diversity ● Critique may be viewed as serious error ● Power dynamics may be different ● Difficulty in exposing weakness ● Consequences of failure ● Older than other learners ● Family circumstances and financial burdens ● Adjustment to new culture and language

An IMG’s Story “An example of a cultural issue I faced during my family medicine rotation was to meet, and examine a transgendered patient - previously a male, now a female. When my supervisor introduced the issue to me, I couldn’t imagine myself seeing the patient, or even talking to her. I felt this was an awkward and uncomfortable situation, which I had never experienced before. I even asked my supervisor frankly not to see this patient. ” Anonymous, 2004

As a Teacher, What Would You Do? ● ● ● “I can’t do it” What do you think is happening with the learner? How could you use feedback to help her?

Commonly Reported Issues ● Medical knowledge ● Clinical skills ● Communication skills ● Language skills ● But these are HIGHLY variable between individuals!

Think of Times When You, as a Learner, Have Received Feedback… ● ● When it was helpful – what was it that made it so? When it was not useful – why was that?

Steps in Delivering Feedback Build an environment of trust and support ● ● Role-model by asking for, and using, feedback Role-model an acceptance of personal gaps in knowledge and skill Convey an awareness that mistakes are inevitable Actively encourage asking for advice/help

Steps in Delivering Feedback Plan ahead and negotiate ● ● ● Feedback shouldn’t come as a surprise Clarify the difference between feedback (coaching) and an evaluation (judgment) Seek out opportunities to observe (more on this later)

Steps in Delivering Feedback Elicit learner self-assessment ● ● ● Helps in understanding learner’s thinking Can determine the most useful points for feedback Helps in gauging the appropriate level of sophistication ● Often the learner will do most of the work! ● But some IMGs are unfamiliar, or reluctant

Steps in Delivering Feedback Choose appropriate timing and setting ● ● As close in time as possible Quickie feedback followed by later discussion if necessary ● Privacy may be necessary ● Emotions may need to settle

Steps in Delivering Feedback Focus on the positive, not just the negative ● ● Teachers tend to be quicker to correct than to reinforce Change is more likely if positive feelings are engendered ● Frame message in positive terms ● Indicate impact of behaviour

Steps in Delivering Feedback Select specific, changeable behaviours ● Tendency to give TOO many learning points – pick 2 or 3 ● Describe observations – be specific ● Pick those that the IMG can CHANGE! ● Focus on previously identified learning needs

Steps in Delivering Feedback Use a feedback model (sandwich or grid) ● ● ● Systematic approaches are helpful PNP sandwich (highlight a positive aspect, then one to be improved, then another positive) Feedback grid adapted from the Bayer Institute (behaviours to continue, or do more of; behaviours to start doing; behaviour to stop or do less of; future behaviours)

Feedback Grid Continue… Start, or do more… Comment on aspects of Identify behaviour the student performance that were effective. knows how to do and should Be specific and describe impact. do, or do more often. Highlight things you would like to see done in the future. Consider… Stop, or do less… Highlight a point of growth for Point out actions that were not the student, a “doable” challenge helpful, or could be harmful. for future interactions. Be specific and indicate potential impact.

Steps in Delivering Feedback Include follow-up plans ● New behaviours need reinforcement ● Implementation is not easy ● Include strategies for putting it into practice ● Follow-up helps reinforce change ● AND highlights successes

In Summary… ● ● ● ● Build an environment of trust Plan ahead and negotiate Elicit self-assessment Determine appropriate setting and timing Focus on the positive Select specific changeable behaviours Use a feedback model Include follow-up plans

Observing Learners. . What Are Your Opportunities and Strategies? In the same room: ● ● ● Keep quiet Avoid eye contact with the patient Turn to the learner if addressed by the patient Use natural opportunities: ● ● Listen to phone conversations Hallway discussions Briefly observe many different parts of encounters

Practice Makes Perfect!