Giving Feedback that Changes Behaviour Deirdre Bonnycastle Clinical Teaching College of Medicine University of Saskatchewan

GOAL – Confident, Competent Physicians Image© University of Saskatchewan

Objectives Upon completion of this module, participants will be able to: Identify three levels of feedback Deliver effective written and verbal feedback using the THANCS criteria.

Upon completion of this module,

participants will be able to:

Identify three levels of feedback

Deliver effective written and verbal feedback using the THANCS criteria.

Why is feedback so difficult? Cartoon by Nick D Kim, http://www.lab-initio.com /

1. Theoretical Underpinnings Summative Assessment Formative Feedback Objectives Learning Activities

1. Theoretical Underpinnings Summative Assessment Formative Feedback Objectives Learning Activities

1. Theoretical Underpinnings Formative Feedback How is formative feedback part of learning to deliberately practice becoming a physician? http://medicaleducation.wetpaint.com/page/Deliberately+Practicing Summative Assessment Objectives Learning Activities

Identify Three Levels of Feedback Based on the work of Dr. J. Hsu-Lumetta Minimum Feedback Based on Undefined Goals. Behavioral Feedback Based on Instructor Goals Interactive Feedback Based on Mutual Goals

1. Minimum Feedback Based on Undefined Goals Why are rewards and punishment ineffective ways to provide feedback?

Why are rewards and punishment

ineffective ways

to provide feedback?

Example Mohamed the Bristly https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/Clinical%20Coaching/Mohamed%20the%20Bristly!%20(Pt1).mov

Mohamed the Bristly

https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/Clinical%20Coaching/Mohamed%20the%20Bristly!%20(Pt1).mov

Self Critique What do you think you did well? What would you change if you were to do it again? Instructor Critique Continue Do more Start Stop Summarize and Mutual Next Steps 2. Behavioral Feedback Based on Instructor Goals

Self Critique

What do you think you did well?

What would you change if you were to do it again?

Instructor Critique

Continue

Do more

Start

Stop

Summarize and Mutual Next Steps

Unconsciously Incompetent Theoretical Underpinning Consciously Incompetent Depending on how the student evaluates themselves, they are moving between…

Unconsciously

Incompetent

Unconsciously Incompetent Theoretical Underpinning Consciously Incompetent Video observation 360 Feedback Stop Start Depending on how the student evaluates themselves, they need …

Unconsciously

Incompetent

Theoretical Underpinning Consciously Incompetent Consciously Competent Depending on how the student evaluates themselves, they are moving between…

Theoretical Underpinning Consciously Incompetent Consciously Competent Identify Behaviour Start Do more Stop Depending on how the student evaluates themselves, they need …

Theoretical Underpinning Unconsciously Competent Consciously Competent Depending on how the student evaluates themselves, they are moving between…

Theoretical Underpinning Unconsciously Competent Consciously Competent Encourage Continue Do more Teach others Depending on how the student evaluates themselves, they need …

Unconsciously Incompetent Theoretical Underpinning Consciously Incompetent Unconsciously Competent Consciously Competent Video observation 360 Feedback Stop Start Identify Behaviour Start Do more Stop Encourage Continue Do more Teach others

Unconsciously

Incompetent

Example Mohamed the Mystified https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/Clinical%20Coaching/Mohamed%20the%20Mystified!%20(Pt2).mov

Mohamed the Mystified

https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/Clinical%20Coaching/Mohamed%20the%20Mystified!%20(Pt2).mov

What changed in the preceptors behaviour and dialogue between these two sessions?

What changed in the preceptors behaviour and

dialogue between these two sessions?

3. Interactive Feedback Based on Mutual Goals The OPEN Model for Delivering Feedback O rient and O bserve the Student Share P erspectives E ncourage Deliberate Practice Plan for N ext Time

The OPEN Model for Delivering Feedback

O rient and O bserve the Student

Share P erspectives

E ncourage Deliberate Practice

Plan for N ext Time

3. Interactive Feedback Based on Mutual Goals The OPEN Model for Delivering Feedback O rient and O bserve the Student Share P erspectives E ncourage Deliberate Practice Plan for N ext Time Best used at Conscious Competence and Unconscious Competence Stage

The OPEN Model for Delivering Feedback

O rient and O bserve the Student

Share P erspectives

E ncourage Deliberate Practice

Plan for N ext Time

Objective 2

Objective 2

Deliver Written and Verbal Feedback Using the THANCS Mnemonic T imely H elpful A ppropriate N ever labeling/demoralizing/shouted C ollaborative & culturally sensitive S pecific

T imely

H elpful

A ppropriate

N ever labeling/demoralizing/shouted

C ollaborative & culturally sensitive

S pecific

Field Notes Date: __________________ Resident ______________________ Supervisor ________________________ Patient: M F AGE______ Diagnosis/Procedure ____________________ Directly Observed □Yes □ NO Selectivity □ Focused/appropriate □ Establish priorities □ Urgent vs. non-urgent □ Complete, thorough Clinical Reasoning Clinical Reasoning □ Hypotheses / Diff. Dx □ Gather data (Hx & Px) □ Interpret data □ Make Decisions □ Set goals / Objectives Professionalism □ Responsible/Reliable/Trustworthy □ Know Limits □ Flexible/Resourceful □ Evokes Confidence □ Caring/Compassionate □ Maintains Boundaries □ Respectful □ Ethical/Honest □ Evidence Influenced □ Community Responsive □ Good Balance □ Mindful Approach Patient centered approach □ Explores illness /disease □ Understand context □ Common ground □ Build relationship □ Be realistic □ Health promotion / prevention Procedural skills □ Decision to Act □ Informed Consent □ Preparation □ During procedure (comfort/safety) □ If problems reevaluate □ After Care/Follow-up Physical Exam □ Appropriate Exam / Technique □ Competent Performance Communication □ Verbal □ Written & Charting □ Listening □ Non-Verbal □ Culture/Gender/Age Appropriate □ Attitudinal  History  Physical  Hypothesis  Investigation  Diagnosis  Procedure  Management/Treatment  Referral  Follow-up Based on Dalhousie University’s work

Selectivity

□ Focused/appropriate

□ Establish priorities

□ Urgent vs. non-urgent

□ Complete, thorough Clinical Reasoning

Clinical Reasoning

□ Hypotheses / Diff. Dx

□ Gather data (Hx & Px)

□ Interpret data

□ Make Decisions

□ Set goals / Objectives

Professionalism

□ Responsible/Reliable/Trustworthy

□ Know Limits

□ Flexible/Resourceful

□ Evokes Confidence

□ Caring/Compassionate

□ Maintains Boundaries

□ Respectful

□ Ethical/Honest

□ Evidence Influenced

□ Community Responsive

□ Good Balance

□ Mindful Approach

Patient centered approach

□ Explores illness /disease

□ Understand context

□ Common ground

□ Build relationship

□ Be realistic

□ Health promotion / prevention

Procedural skills

□ Decision to Act

□ Informed Consent

□ Preparation

□ During procedure (comfort/safety)

□ If problems reevaluate

□ After Care/Follow-up

Physical Exam

□ Appropriate Exam / Technique

□ Competent Performance

Communication

□ Verbal

□ Written & Charting

□ Listening

□ Non-Verbal

□ Culture/Gender/Age Appropriate

□ Attitudinal

Field Notes Back Continue (Strengths): Do More (Area for Development): Consider (Learning Objectives) Stop: (or do less) Reporter  Interpreter  Manager  Educator  Procedure competence achieved  Resident’s Initials ____________ Supervisor’s Initials ______

Continue (Strengths):

Do More (Area for Development):

Consider (Learning Objectives)

Stop: (or do less)

Reporter  Interpreter  Manager  Educator 

Procedure competence achieved 

Resident’s Initials ____________ Supervisor’s Initials ______

Clinical Example https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/first%20postings/Dr.%20Cline/Dr.Cline3.5.mov

https://www.emap.usask.ca/client_downloads/TEL_Health_Sciences/first%20postings/Dr.%20Cline/Dr.Cline3.5.mov

Practice Using Written Feedback Using the field notes, provide feedback to the student in the video on their procedure and patient interaction skills. Share your feedback with the person on your left Discuss in the large group.

Using the field notes, provide feedback to the student in the video on their procedure and patient interaction skills.

Share your feedback with the person on your left

Discuss in the large group.

Practice Using Verbal Feedback Divide into pairs, one person will be the instructor; one the student from the video Give the student feedback Student give the instructor feedback on how they gave feedback 15 Minutes

Divide into pairs, one person will be the instructor; one the student from the video

Give the student feedback

Student give the instructor feedback on how they gave feedback

15 Minutes

Discuss

Discuss

T h a n k y o u Read more about feedback here http://medicaleducation.wetpaint.com/page/Feedback

T h a n k y o u

Read more about feedback here

http://medicaleducation.wetpaint.com/page/Feedback