Feedback forms an essential component of personal development in medicine and ultimately serves to improve patient care, it can be formal or informal and vary in the source from peers, colleagues to patients1. Navigating the intricacies of requesting, receiving and giving feedback will help to develop yourself as a clinician and these skills can be used even in non-medical settings!
They key concept of feedback as opposed to evaluation is that it is formative whereas an evaluation is summative2. This post is a summary of the different techniques that can be used and I would encourage further reading for those interested in the in-depth details, the articles reviewed here are available free on the internet (see references).
Requesting feedback
The first step before asking for feedback is to assess yourself and identify areas required for improvement3. This will help you to convey the areas you would like assessed more effectively.
Arrange short and regular meetings with your supervisor and inform them it is aimed at receiving feedback so that any areas of improvement are highlighted early and there is time to work on them. This is in addition to the compulsory reviews that are required for your training and if your supervisor has a very busy schedule you can even have these meetings with a senior doctor.
When you would like feedback on a particular activity inform your supervising doctor before you start so that they can prepared themselves to give you good quality feedback.
Discuss beforehand what in particular you are asking to be assessed on and stick to 1-2 areas so that the feedback that receive will be specific to this. Too much feedback can overwhelm you and become difficult to reflect on it later2.
Ask a variety of different people for feedback such as nurses, allied health care staff and you will find the feedback you receive is often focused on a different aspect to that of your colleagues.
If you are preparing a multi-source feedback it is recommended to choose a range of different colleagues from different disciplines to reflect your interaction with the multidisciplinary team.
Receiving feedback
Once you receive feedback document it in your portfolio and then reflect on it (both the positives elements and areas for improvement).
The reflection should highlight what you have learned from the event and action plans can be recorded as SMART (specific, measurable, attainable, realistic, time orientated) goals.
If your feedback is overwhelmingly positive it can still be reflected on the same way as any suggestions for improvement. For example, if the supervisor assesses your suturing skills to be exemplary, you can still reflect to say why the technique was good and how you can continue to perform at this level as well as identify ways to expand your skills.
Be prepared for feedback or comments that you do not expect and try to avoid defensive responses, but instead explore any reasons for the feedback with the supervisor. The Johari window is a good tool to describe our blind spots but known to others3.
Don’t forget to thank the supervisor for their feedback! It will help you to build a good working relationship if you can demonstrate gratitude for their time and effort2.
Patients and visitors provide verbal feedback often at the end of a hospital admission or even write a thank you card. It is very helpful to record this (confidentiality maintained) in your portfolio and it helps you develop your insight into how patients perceive you.
Giving feedback
Feedback should be given in a timely fashion to ensure it will have the greatest impact and allow time for any improvements to be implemented.
Use non-judgmental communication (verbal and non-verbal) and employ pauses to allow the feedback to be an open discussion.
Avoid generalised feedback and instead use specific examples to explain why an event went well and did not go well to help develop the action plan jointly.
Ask if there is anything that they would like to feedback to you. This can help you improve the facilitation of any future learning events and assist in your own development. This can be added to your portfolio as a reflection.
Offer a follow up session to discuss progress and encourage short and regular ‘catch-ups’ to build a good working relationship.
Models for giving feedback
Sandwich Method: firstly giving positive points then improvements, and ending with positive feedback1.
Pendleton Method: using open questions and encouraging the learner to self-reflect on the events and attempt to identify what was done well, what could be improved and how it can be achieved1.
Chronological fashion feedback: reviewing events that occurred in a chronological order and giving either positive feedback or improvements for the events1.
Ask-tell-ask: this is where the learner assesses their own performance first then the supervisor offers their feedback then checks the understanding of the learner2.
Summary
Feedback is a very useful way to make small but impactful changes and when used effectively progress can lead to improved patient care, better patient satisfaction and interactions with the multi-disciplinary team. The key principles are to request specific feedback and record this in a reflection with SMART action plans.
References
Hardavalla, G et al (2017) ‘How to give and receive feedback effectively’, Breathe, Vol. 13, no. 4, pp. 327-333.
Jug, R et al (2019) ‘Giving and receiving effective feedback: a review article and how-to guide’, Archives of Pathology and Laboratory Medicine, Vol 143, no 2, pp. 244-250.
Algiraigri A (2014) ‘Ten tips for receiving feedback effectively in clinical practice’, Medical Education Online, doi: 10.3402/meo.v19.25141 (accessed on 20/02/2021).
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