Student resilience and instructor feedback
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Presentation at the UCLA David Geffen School of Medicine Annual Problem Based Learning Instructor Conference
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Student resilience and instructor feedback
- 1. Sharon Younkin, Ph.D. September 12, 2014 Annual Experienced PBL Tutor Conference
- 2. Having the capacity to respond to stressors and setbacks in a healthy way, such that goals are achieved at minimal psychological and physical cost.
- 3. Self-efficacy Internal locus of control Problem solving skills Openness to learning from mistakes Commitment/Persistence Flexibility Reflection skills Emotional self-regulation Availability of social support Willingness to seek assistance
- 4. What qualities and/or characteristics do you notice in resilient students?
- 5. Having a sense of personal control ◦ “My behavior can influence this situation.” Flexibility ◦ “I can change my……study habits, time management strategies, etc………to increase my effectiveness.” Having the ability to de-construct adverse experiences and focus on lessons learned ◦ “I can use this information to improve my performance.” Persistence ◦ “Setbacks are inevitable but surmountable-I didn’t do well on this exam but I will figure out how to do better on the next exam.” Having the ability to identify emotional reactions and modulate them ◦ “Critical feedback makes me uncomfortable, but I can manage those feelings and use them as motivation.”
- 6. Utilizes reflection skills ◦ “What can I learn from this setback that will increase the likelihood of future success?” Possesses self-awareness—does not confuse self with behavior ◦ “Failing at this task does not mean I am a failure—I have the capacity to succeed.” Seeks help when needed ◦ “I can pass this class but I’ll need some assistance.” Maintains a sense of optimism and hope ◦ “Working hard is worth the effort, I can do this.”
- 7. Establish a feedback culture Help students set clear, specific goals ◦ Challenging but within reach Give students choice and control over some aspects of their learning Use peer modeling ◦ Observing peers succeed can help motivate students
- 8. Provide frequent, straightforward, explicit feedback ◦ Use a coaching model, incremental steps toward mastery Verify understanding and the development of an action plan Facilitate accurate self-evaluation ◦ Ensure that students are able to accurately judge their performance and adapt accordingly
- 9. What have been your experiences with resilient and non-resilient students? What behaviors have you discovered that have helped develop resilience in your students?
- 11. ◦ Formative v. Summative ◦ Directive v. Facilitative ◦ Bi-directional v. Uni-directional ◦ Challenge v. Support ◦ Immediate v. Delayed ◦ Delivered v Received ◦ Verifying v. Elaborative
- 12. Feedback success stories ◦ Share examples of your feedback conversations that have resulted in improved student performance.
- 13. Challenging experiences assist in the development of resilience Recurrent experiences of overcoming difficulties and achieving goals increases resilience and self-efficacy Feedback and coaching convey that improvement is possible Positive feedback about quality work and effort provides information about strategies that are working
- 14. Reflection ◦ Self-evaluation + external evaluation Goal-setting ◦ Specific learning goals + instructor identified aspirational goals Locus of control ◦ Identifying what behaviors need to change in order to improve performance Motivation ◦ Willingness to utilize feedback and persist through challenges Self-esteem ◦ Confidence in ability to utilize feedback Emotional self regulation ◦ Receive feedback in a neutral fashion
- 15. Creating a culture of feedback On the fly, verbal input ◦ real-time feedback in class Frequent written feedback on written work Summative—PBL Evaluation forms
- 16. How can we improve feedback content and feedback delivery strategies in PBL?
- 19. Archer, J. State of the science in health professional education: effective feedback. Med Educ (2010) 44:101- 108. Artino, A. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ (2012) 1:76-85. Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. (1977); 84: 191-215. Dyrbye, L. et. al. Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students. Medical Education (2010): 44: 1016-1026. Howe, A., Smajdor, A., Stockl, A. Towards an understanding of resilience and its relevance to medical training. Medical Education, (2012): 46: 349-356.
- 20. Kluger, A, DeNisi, A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psycho Bull (1996); 119 (2): 254-84. Watling, C., et. al. Learning culture and feedback: an international study of medical athletes and musicians. Medical Education (2014); 48:713- 723. Wood, D. Understanding medical education: evidence, theory and practice, second edition. Edited by Tim Swanwick. (2014). The association for the study of medical educaiton. John Wiley and Sons, Ltd. Pp 317-328.
Editor's Notes
- Educating future physicians is a noble endeavor made possible through the generous contributions of volunteer faculty. Thank you all for your gracious gift to UCLA and to our medical students. I’m honored to have this opportunity to talk with and learn from you all today. Dr. O’Neil asked me to share some thoughts about student resilience, most especially as they relate to the delivery of and response to faculty feedback. Resilience and academic success are linked. Resilience can influence how we respond to and utilize feedback, and feedback can be a critical component in developing resilient students. So, it seems worthwhile to explore how these two things can help our students succeed.
- Resilience refers to capacity to respond to stress and setbacks, essentially how we respond to life’s challenges. Resilient people are able to face the vicissitudes of life in stride, learning from mistakes and maintaining a willingness to persevere. Everyone gets knocked down—it’s how you get back up that matters. Resilient students are able to respond positively to challenges, including critical feedback, which ultimately is linked with improved academic and professional performance as well as general life effectiveness, health, well-being, and self-esteem. Faculty can have a significant impact on building and maintaining student resilience as they matriculate through medical school.
- There are a variety of components which contribute to resilience including: • Self efficacy • Locus of control • Problem solving skills • Learning from our mistakes • Commitment • Persistence • Flexibility • Reflection • Emotional self-regulation • Social support • Willingness to seek outside help and guidance as needed While some components of resilience can be considered characterological, resilience is really like physical fitness—we can all exercise and improve our fitness in overall and specific ways. The environments we create, the things we say, and the support we offer to students can all help build their resilience.
- Expanding our definition of Resilience specifically to students, we know that resilient students Focus on what they can control, they are flexible and roll with the punches, they can mine their adverse experiences and identify pertinent lessons, they are persistent and tenacious, believing in their capacity for success. they can manage their emotional reactions. We can help students increase their resiliency by focusing on what they can control or change— their own behavior and reactions. For example: Identifying what skills they can develop and/or improve, and maintaining a focus on their personal behavior NOT what’s beyond their control (volume of information, course schedule, etc.). We want to ensure that medical students are able to handle adversity and challenges without becoming paralyzed by anxiety or by withdrawing. Helping students understand the reasons behind their performance and confirming that they feel capable of improving is critical, especially for students who have less well developed resilience skills.
- Resilient students also are able to reflect on their performance and behavior, developing an understanding of what has contributed to their successes and failures. They can clearly identify the differences between their personhood and their behaviors. A key factor is their willingness to utilize resources and support. Normalizing help seeking, and confirming that all students know what resources are available to assist them increases the likelihood that students will seek help sooner rather than later. Finally, the resilient student is not a Pollyana, but has a reality-based optimism in their ability to rise to the challenges at hand.
- PBL is a great environment in which to build student resilience. Most importantly, we establish a foundation by creating a culture in which feedback is expected and appreciated. It’s important to ensure that all students are able to provide clear, specific, actionable feedback to each other. We have multiple opportunities to help students with goal setting, specifically with developing short term goals: what can they do to improve their performance in the next class session. Students have some decision making power in terms of their responsibilities in the course, thus empowering them and building their sense of control and resilience. Having the opportunity to observe their peers in teaching roles provides many opportunities to view their peers succeeding, thus providing them validation that success at their level is possible.
- Obviously, feedback is key in the development of resilience. The medical school model involves feedback and evaluation designed to lead to competence. In contrast, a coaching model is based on incremental steps toward mastery. Coaching consists of a lifetime of small, discrete tips designed lead to perfection. Just as important as feedback is the need to verify that the feedback was understood and helping the student develop a plan to address the identified issue. Finally, some students may overestimate their capabilities--clear, direct and immediate feedback is the most effective way to help students calibrate accurately.
- One challenge some instructors identify in this generation of students is that they were raised in a culture in which anyone who shows up gets an award. While that may or may not be true of our students, we know this is not the case in medical school, especially as they move into the clinical years. Fortunately, PBL offers one of the best environments in medical school in which to provide feedback.
- You all already know about the various aspects of feedback, but for the sake of thoroughness, let’s briefly review some of the key components. Ideally, we’re giving students solid, specific, formative feedback in every class session and on all of their written work, as well as clear statements about their successes and areas for improvement through our summative feedback. Our directive feedback informs our students of what requires correction, while our facilitative feedback provides the comments/suggestions necessary for them to self-correct. As we know, real-time or immediate feedback is very powerful, however, delayed feedback may facilitate better transfer of knowledge, as students have had time to think about their performance. Some student surveys suggest that, while many faculty believe that they give students frequent feedback, students report receiving very little feedback, which speaks to the importance of checking to ensure that the student hears and understands the feedback you provide—in other words, we know we provided feedback, but does the student know that? It can help to check! Lastly, verifying feedback simply identifies that the student has provided correct or incorrect information. Whereas elaborative feedback or questioning is designed to help the learner reach the correct answer on their own—exactly what PBL is designed to do.
- I’d like to talk more specifically about the relationship between feedback and resilience. Obviously, feedback can be challenging to students, providing them many opportunities to understand and overcome difficulties, and learn from their mistakes. Critical feedback, sensitively delivered, helps students understand that they can improve and succeed. While critical feedback and overcoming adversity and setbacks are key in developing and maintaining resilience, receiving reinforcement and acknowledgement is also important. Specific positive feedback helps students know what behaviors they should continue, reinforces their self-confidence, and fuels their hopes for achieving their goals. But, just as with statements such as “I think you can do better”, statements like “good job” do not provide students with any clear indication about what they did that contributed to their success. While those statements feel good to say and feel good to the student, spending some time articulating exactly what components of the work were successful will better help the student’s resilience.
- Let’s return to some of the skills and characteristics contributing to resiliency, specifically as they relate to the effective use of feedback. Reflection, goal-setting, locus of control, motivation, self esteem and emotional self-regulation all play key roles in our students’ ability to effectively use feedback. Ensuring that students have good reflection skills and that they take the time to think productively about their performance will help the student become more self-reliant in their educational endeavors and assist them as they develop their personal goals. Receiving feedback about behaviors that are within their control, and which will increase the likelihood they will reach their goals, contributes both to their success and self-esteem. We want to ensure that we do all we can to keep our students motivated and confident. It’s also important to pay attention to their emotional expression—if they have challenges in terms of their emotional responses to feedback, it may be important to connect them to the appropriate support resources.
- Problem based learning offers one of the best environments for developing resilience in students. Obviously, we have many opportunities to offer students feedback—in real time, on written work, in consultation, and/or on their evaluations. In PBL, students have an opportunity to develop relationships with faculty over a longer period of time than they do in many other classes, setting the stage for more risk taking and openness to feedback. They are able to engage in goal directed conversations that boost their problem solving skills and their cognitive flexibility. They interact frequently with peers and faculty and have many opportunities to receive feedback—in class, on their written contributions throughout the week, as well as through typical end of course evaluations. In summary, in PBL you are primed to provide students with key feedback experiences that can significantly contribute to their resilience.
- Just as we want to provide feedback to ensure our students are performing at optimal levels, we want to ensure that our teaching and our classes are providing the optimal learning environment for students. Toward that end, we’d love to hear your thoughts about how we can improve the feedback mechanisms in PBL.