Heidi Combs MD MS Associate Professor Vice Chair of Education University of Washington Department of Psychiatry amp Behavioral Sciences Stern Endowed Chair for WWAMI Faculty Development Objectives At the end of this talk the participant will be able to ID: 1047640
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1. Family Medicine Faculty RetreatHeidi Combs, MD, MSAssociate Professor, Vice Chair of EducationUniversity of Washington Department of Psychiatry & Behavioral SciencesStern Endowed Chair for WWAMI Faculty Development
2. Objectives: At the end of this talk the participant will be able to: Understand the Stern Education program and how it can help youReflect on your strengths and challenges with feedback.Describe key featured of feedback toolsDescribe approaches to manage barriers to feedback
3. Stern Regional Educators
4. BackgroundPauline and Edgar Stern donated funds to create the Stern Endowed Chair for Medical Education Focus of program is to support training of WWAMI Faculty working with medical students
5. The Stern Regional Educators are a resource to help support faculty development around teaching medical students.
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7. Completed needs assessment of region including topics and preferred methods of deliveryIdentified Six Stern Regional Faculty Educators
8. Please allow me to introduce
9. WASHINGTON – EASTERN JUSTIN FREDERICK, M.D., Clinical Assistant Professor, Department of Radiology, UW School of Medicine, Providence Sacred Heart Medical Center, Spokane WASHINGTON – WESTERN SUSAN MEREL, M.D., Associate Professor, Department Of Medicine, UW School of Medicine, University of Washington WYOMING BETSY SPOMER, M.D., Clinical Assistant Professor, Department of Family Medicine, UW School of Medicine, University of Wyoming ALASKA TONI BISKUP, M.D., M.P.H., Adjunct Faculty, Departments of Internal Medicine and Pediatrics, UW School of Medicine, University of Alaska Anchorage MONTANA LAURA GOODELL, M.D., Clinical Assistant Professor, Department of Family Medicine, UW School of Medicine, Montana State University IDAHO ANDREA CHRISTOPHER, M.D., Assistant Professor, Department of Medicine, UW School of Medicine, Boise Veterans Affairs Medical Center
10. Our topics!
11. For each topic we will have:Slide sets- short and longNarrated slide setsCase based lecture with small group activitiesPodcastArticles
12. Are in communication with other stakeholdersCLIMEClerkship DirectorsRegional Deans
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14. Take a moment…..Think about the best student you have worked with Think about the above average student you worked with Think about the average student you worked with
15. Ever had a student who…
16. Our challenge
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18. Key Steps to Teaching Effectively
19. ExpectationsExpectations are the basis of performanceNo one likes to not know what they should be doingSet expectations at the beginning of the rotation and refresh them often
20. Matching learner states to teaching styles for optimal engagementTeacher stylesAuthoritativeMotivator/facilitatorDelegatorDependent learnerMatchLearner will get mired in the detailsLearner will feel lostLearnerstagesInterested learnerLearner will not self elevate to self directionMatchLearner will not feel supportedSelf-directed learnerLearner feels micromanagedLearner will not benefit from the motivation of ownership of tasksMatchGrow. G. Teaching learners to be self directed. Adult Educ Q 1991;41:125-129
21. AssessmentHelps the teacher know where the learner is at and what the learner needsHelps the teacher determine what sort of deficits are present so appropriate feedback can be given
22. Assessments flow from expectationsSet expectations at the beginning of the rotation and refresh them oftenIf the expectations are not known by the learner, the feedback based on the assessment will feel unsubstantiatedAssess multiple eventsEveryone has good and bad moments – recognize patternsWrite down notes of what you thought at the time
23. Challenges with assessmentsWe tend not to distinguish between items- if a learner performs well in one area we tend to assess them well in other areas (halo effect)Turnbull J., Van Barneveld C. Assessment of clinical performance: in-training assessment. In: Normal GR, van der Vleutem CPM, Newble DI editors. International handbook of research in medical education. Dordrecht, Netherlands:Kluwer Academic Publishers, 2002;793-810
24. Personality traits (e.g. extroversion, introversion) may have a positive or negative impact on our assessmentTurnbull J., Van Barneveld C. Assessment of clinical performance: in-training assessment. In: Normal GR, van der Vleutem CPM, Newble DI editors. International handbook of research in medical education. Dordrecht, Netherlands:Kluwer Academic Publishers, 2002;793-810
25. Why do we struggle with feedback?
26. What Is Feedback?Feedback is the constructive and objective appraisal of performance given to improve skillFormative feedback:An appraisal of the skills demonstrated in the here and nowPurpose: Improving specific skillsFeedback should be specific, objective, and directSummative feedback:A general appraisal of overarching skills and abilitiesPurpose: Assessing competency, document achievementFeedback is more general, but should have specific situations and occurrences which support both positive assessments and areas for suggested improvementBienstock, J. et. al. To the point: medical education reviews – providing feedback. American Journal of Obstetrics & Gynecology 2007;508-513.
27. Feedback flows from assessment
28. Why Is Feedback Important?Feedback is essential to accurate self appraisal of skills and improvement on skillsWithout feedback, alternative feedback is created by the learner and other assessments are overvalued. Memory is valued over clinical skillPhysicians significantly overvalue their current skill level and give poor self assessmentsWithout feedback, no one gets any betterBing-You, R., Trowbridge, R. Why Medical Educators May Be Failing at Feedback. JAMA 2009;302:12:1330-1331.
29. General principles regarding feedbackEffective feedback is a function of Learners level of awareness of what is being reflectedThe learner’s perception of the purpose of and the impartiality of observationsRapportCouch the feedback in the learner’s perspective and expectations. If they feel you have their best interest in mind they can hear what you have to sayTry to consider where the learner is coming from with regards to their performanceBe aware of your cognitive or emotional biases
30. Giving feedbackBe fair Be specificBe consistentBe constructiveBe timelyBe flexibleBe openBe collaborativeDo it in an appropriate settingPsychiatric Residents As Teachers: A Practical Guide Second Revision Committee on Graduate Medical Education 2001-2002
31. What you sayYou are doing a great jobWhat they hearYou are an honors studentYou are right where I would expect you to be at this stage of the clerkshipKeep doing what you are doing, you are on the right trackYou are doing honors workYou are going to get honors
32. Feedback toolsEasy to remember tools to remind you to:Encourage reflection by the learnerDescribe the behavior or situationPlan the changes that will be implemented
33. Ask Tell AskAsk for self assessment (ASK)Ask the learner what went wellAsk the learner what could be improvedGive your assessment- be specific (TELL)Describe what you noticed that went wellDescribe things you think could be improvedCouch this in the experience of the learner to demonstrate the value to the learnerMake sure to allow the learner to comment on the feedbackIf the learner does not own the feedback provided, they will not hear what you have said and are less likely to apply the informationMake an action plan (ASK)Plan, reflect, and analyzeBienstock, J. et. al. To the point: medical education reviews – providing feedback. American Journal of Obstetrics & Gynecology 2007;508-513.
34. ADAPT (Ask-Discuss-Ask-Plan Together)
35. Better than nothing but….
36. Barriers to feedback?
37. Barriers to FeedbackLack of knowledge on what to give feedback about*Lack of training about how to give feedback* Lack of timeWorry feedback will be misinterpretedWorry about the impact on your relationship with the learnerNot wanting to deal with the aftermathFiona Lake Teaching on the run tips:doctors as teachers. MJA 180:415-415 April 2004
38. No time?
39. Change your mindset about feedbackFeedback often should take less than 5 minutes!!It is more valuable to give feedback snippets along the way!It is not helpful to hose them down at the end!
40. Worry the learner will misinterpret the feedbackIf you have set the stage using techniques reviewed the chance of misinterpretation is much lessDirect feedback that is constructive is difficult BUT ESSENTIAL. We do not live in Lake Wobegon. The West Coast nice doesn’t serve learners well.
41. Test question A. If I give more honors my life will be easier 1) No 2) Yes 3) DependsNobuhiro Hagura Patrick Haggard, Jörn Diedrichsen Perceptual decisions are biased by the cost to act Neuroscience 10.7554/eLife.18422 Feb 2017
42. Final feedback note! Set your plan for follow-upHow will you know if this plan is successful?When will you follow-up with the learner?Having a plan for follow-up and measurement of success helps all sides see growth and progressValidates the learnerAllows the teacher to adjust aspects if neededWithout follow-up, your plan will lose momentum quickly and easily
43. Feedback Pearls
44. Feedback Pearls