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Feedback answers the question, "How
am I doing"? Giving feedback effectively is key to effective
precepting. You will also improve your precepting skills by
eliciting and incorporating feedback.
Principles of Effective
Feedback
Feedback should be helpful to the
person who receives it. Feedback will be most helpful when
the student:
- Understands the
information
- Is able to accept the
information
- Is able to do something about the
information
Some Valid Assumptions About
Feedback
- Everyone deserves
feedback.
- Saying the right words is not
nearly as important as knowing why you are saying them.
- Negative feedback (or criticism)
will most often be uncomfortable for both parties.
- Positive feedback can be equally
uncomfortable, but no less needed.
- Your values will never be 100%
matched by anyone else.
- Influencing is balanced by being
influenced.
- The search for truth should never
end.
Guidelines for Giving
Feedback
1. Focus on
CHANGEABLE THINGS.
- Feedback can lead to improvements
only when it is about things which can be changed.
- Share ideas and information and
explore alternatives rather than expecting answers or
solutions.
2. Make DESCRIPTIVE NOT
INTERPRETIVE statements.
- Act as a video camera.
Playback a report of your observations rather than your
interpretation about why things happened or what was meant by
them. If you observe a practice that the student needs to
improve, state your observation and then ask questions such as,
"How could you do that more efficiently?" or "How could you do that
procedure more safely?" or "What was a risk or potential problem
with that approach?"
- Focus on the behavior, not on the
person.
3. Make SPECIFIC
statements.
- Look for details.
- Give concrete and objective
"playback."
- Focus on the student's actions (or
sequence of actions, or omitted actions).
- Offer specific positive, as well as
corrective, statements. "Good job," is too general; state
what exactly was "good" and why.
- Give specific suggestions about how
to improve.
4. Give IMMEDIATE
feedback.
- The sooner feedback is given, the
more effective it will be.
- When you must delay, identify the
specific time or incident to which you are referring.
- Many occasions will arise when you
must defer feedback. You may defer feedback to avoid delays
in care, to avoid embarrassing the student, or for other
reasons. Because such delays are appropriate in the practice
environment, it is important to make a habit of giving feedback at
the end of the day.
5. Choose APPROPRIATE
TIMES.
- Give feedback when the receiver is
ready to become aware of it. Of course, issues of safety,
ethics, or legal requirements take precedence over the student's
readiness to receive feedback.
- Critical feedback in front of
others may be more damaging than helpful.
- Feedback provided should serve the
needs of the recipient rather than the needs (for "release") of the
giver.
6. Choose ONE ISSUE at a
time.
- Focus on the most critical behavior
needing feedback at the time.
7. Do NOT DEMAND A
CHANGE.
- Giving feedback and helping the
student explore alternatives is not the same as requesting or
demanding that the student change. There will be occasions
when you request or demand changes in student practice.
However, keep in mind the video playback analogy. Share your
observations and perceptions with the student, reflect on your
observations with the student, and encourage the student to develop
the habit of reflecting on practice.
I-Messages
The I-message is a specialized
communication technique that is useful in giving feedback.
When you use an I-message, you "own," or take responsibility for
your communication. The technique is often recommended for
communicating assertively and resolving conflicts. The
technique clarifies and accentuates the personal significance that
the speaker places upon the topic of discussion. The
technique avoids the blaming or criticizing tone of you-messages,
such as, "You really need to work on your charting," or "You always
overlook that part of the assessment." I-messages addressing
these same problems might take the form: "When I review your
charting, I notice that the history lacks recent information." or
"When I review your assessment findings, I don't get enough
information about functional capacity to make a sound
diagnosis."
I-messages provide a format for
giving the "video-playback" with some interpretation of the
significance of the observations. Give the student an
opportunity to respond to the I-message. Then, reflect back
the student's response so that he or she can elaborate and so that
you validate our understanding of what the student has said.
Next, give specific criteria for improvement and ask what the
student needs to achieve those criteria. Together, agree upon
what the student, or each of you, will do to facilitate the needed
improvement.
In most situations, your statement
of the criteria is enough and the student can follow through with
your guidance. But, when a pattern of substandard performance
or an apparent attitude problem has developed, the process of
eliciting the student's perceptions and negotiating a solution
assumes greater importance.
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Step-by-Step
I-message process to Negotiate a Plan for
Improvement
- When I ? (review, watch, hear, see,
check ? etc.)
- I ? (notice, wonder, need more, get
concerned about, think there's a risk of ? etc.)
- And, I feel ? (if expressing a
feeling is appropriate to the situation)
- THEN, use active listening to
clarify the student's response. That is, reflect back to the
student whatever he or she says in response to your
I-message. Doing so will encourage the student to further
clarify his or her perceptions of the situation.
- THEN, express the criteria for
improvement as you see them (e.g., more detailed charting about
recent history, better assessment of functional capacity ?
etc.)
- AND elicit from the student his or
her needs in the situation (more assistance, some examples, more
practice).
- FINALLY, negotiate what the
student, or each of you, will do to facilitate the needed
improvement.
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Consult with your faculty contact at
any time that you begin to perceive problematic patterns,
attitudes, or serious deficiencies in performance. Your
perception is sufficient reason to express concern to the faculty
member. The faculty member will appreciate receiving early
notice of problems or potential problems and will assist
you.
Reciprocal Feedback between
Preceptor and Student
Seek feedback from the student about
which of your approaches are most helpful and which are not
helpful. Let the student know that you expect feedback just
as you give feedback on an ongoing basis. Acknowledge and act
on the feedback the student gives you. If you choose not to
act on the student's feedback, let the student know that you
considered it and why you chose not to. This will keep the
atmosphere receptive for feedback. By eliciting and
reflecting on student feedback, you take advantage of letting the
student help you learn to teach while you help the student learn to
practice.
Feedback
Practice
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Positive
Feedback: A Sentence-Completion Assessment of
Strengths
1. One thing I like
about you is ?
2. One thing others like
about you is ?
3.
One thing you do very well is ?
4. A
recent problem you handled very well is ?
5. You are at your best
when ?
6. A
compliment that has been paid to you recently is ?
7. A
value that I see is important to you is ?
8. An example of your
caring about others is ?
9. People can count on
you to ?
10. You did a
good job when ?
11. Something
you are handling better now is ?
12. One thing
you've overcome is ?
13. A good
example of your ability to manage a complex patient is ?
14. You're best
with people when ?
15. If I wanted
to say one good thing about you, I'd say ?
16. One way in
which you are very dependable is ?
17. You have
been able to meet your goal of ?
18. You
pleasantly surprised me when ?
Write two statements of
positve feedback to a student that makes sense in your
practice.
19.
20.
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Some I-message
Examples
Note that statement
B, the I-message, takes responsibility for the communication and
gives more specific information.
1. A. You
should exercise every day.
B. I have
found that I feel better if I exercise every day.
2.
A. Everyone thought you did a great job on
that committee.
B. I
thought you represented my opinion very well as a member of that
committee.
3. A. Our
supervisor doesn't listen to us enough.
B. I would
really like it if my supervisor would spend some time with me
individually.
4. A. No one
likes to talk about her personal life.
B. I am not
comfortable discussing my personal life.
Below each of the following
statements, write a more appropriate statement to open
communication with the student about the issue. See the
suggested I-Messages below.
1. You have a bad
attitude!
2. You should be more
careful!
3. You're always
late!
4. You should get your work
done early like Sam does!
5. You're a real trouble-maker
and you are insensitive to others. And, you're always late
and you always interrupt people!
6. Your documentation was a
real mess last week!
7. Why did you talk to the
secretary that way this morning? (angry tone)
8. You never carry through on
anything I ask you to do, and then I have to be responsible for it!
You're so undependable.
9. You always want things your
way!
10. You're so
disorganized!
Suggested
I-Messages
In the boxes, you will
find some "right" answers to open communication with the
student about the issue. There are other perfectly
appropriate ways to apply the principles of feedback and
I-messages.
1. You have a bad
attitude!
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I heard you telling Mrs. Lane
that you "have no idea" how she might handle the problems she has
been having with our billing and her insurance company. It
sounded to me as though you didn't care about helping
her?
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2. You should be more
careful!
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When I notice that you've omitted
this part of the history and physical from your charting again, I'm
concerned?.
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3. You're always
late!
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I've seen you come in 15 minutes
late three times now ?.
(Follow up with: How will
you prevent this from happening again?
OR
How
will you make sure you're here on time from now
on?)
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4. You should get
your work done early like Sam does!
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I notice that you seem to have a
half hour's worth of paperwork left at the time you're scheduled to
leave?.
(Follow up with: How will
you plan differently to finish on time?)
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5. You're a real
trouble-maker and you are insensitive to others. And, you're
always late and you always interrupt people!
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(Take one issue at a time.
Complete one before bringing up the others)
When I heard you make that remark
about "fat people," I felt badly that our secretary Jane overheard
it because she really struggles with her weight. I was
embarrassed.
(After student's response, clarify
the expectation.)
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6. Your documentation
was a real mess last week!
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When I read this note, I get
confused because you skip from one problem to another and then come
back to the first?.
(After the student's response,
clarify the expectation. Then give guidelines and principles
for revising and instruct the student to rewrite the
entry.)
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7. Why did you talk
to the secretary that way this morning? (angry
tone)
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When I overheard your
complaints to the secretary this morning, I thought you insulted
her?.
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8. You never carry
through on anything I ask you to do, and then I have to be
responsible for it! You're so undependable.
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After you left yesterday, I
discovered that you left those physical exam reports
incomplete. We agreed that you would do them before
leaving?
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9. You always want
things your way!
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When we recognized the schedule
you had set up, I got the impression you were
angry?.
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10. You're so
disorganized!
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After you began the
procedure with Mrs. Gale, I noticed that you had to interrupt the
procedure because you hadn't brought in all of the specimen slides
you needed. I remember that same thing happened yesterday
with Mrs. Harris?
(Follow up with: How can
you be sure that you've brought in everything you
need?)
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Not only do both preceptor and
student participate in planning for improvement, both should also
participate in identifying areas for improvement. During
end-of-the-day feedback sessions, ask the student to identify areas
in which he or she perceives a need to improve.
When you identify a need for
improvement in student performance, bring it to the attention of
the student in a timely manner. Do not hesitate to discuss
the situation with the faculty member.
The Corrective
Interview
1. "I'd like to talk with you
about your work."
2. "One thing I'd like to help
you with is ?." (be specific)
a.
Objective description of the deficit
b.
Statement of observed effects
3. "Is this the way you perceive
the situation?"
4. LISTEN
5. Clarify questions.
a.
If there is a disagreement, acknowledge it, then:
"I
still have these concerns?."
b.
If the student introduces new information:
"That
changes things."
When you both agree on the definition
of the problem:
6. "What do you suggest we
do?"
7. LISTEN
8. "Suppose we try
...."
9. "So, we've agreed to ...."
(review the agreement in detail)
10. "We meet again on ... to review the
progress we've made."
11. "Here are some of the things you
are doing well ...." (be very specific)
When you identify areas in which the
student needs to improve, be specific about the deficiency, the
expectation and resources that can assist the student. You
may wish to formalize these expectations for improvement in
writing, including dates for review and completion. Consult
with the faculty member about formalizing such improvement
plans. Whether or not an improvement plan becomes a written
and/or official document, assure that you, the student, and the
faculty member share the same understanding of improvement needed
and expectations. Improvement plans may also be outlined by
the student for areas in which he or she has identified a need for
improvement.
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A Student Designed
Learning Plan
| Learning
Deficiency: |
Poor
visualization and repair of episiotomy
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| Satisfactory
Performance: |
Ability to identify
layers involved in episiotomy |
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Ability to suture
episiotomy with minimal coaching
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| Unsatisfactory
Performance: |
Failure to identify
layers accurately |
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Failure to repair
episiotomy appropriately
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| Steps to
Resolution: |
Practice on foam and
placentas |
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Review physiology of
the perineum |
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Review steps of
episotomy repair |
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Demonstrate technique
on placenta
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| Learning
Resources: |
Appropriate texts,
videos, or other materials
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| Date for
Review: |
Date
___________________________________
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| Date for Completion
of Plan: |
Date
___________________________________
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| Signatures: |
Faculty
_________________________________
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Student
_________________________________
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Preceptor
_______________________________ |
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In the box below, create a learning
plan for some aspect of practice that might be especially
challenging to a student who is working with you.
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Learning
Plan
Learning
Deficiency:
Satisfactory
Performance:
Unsatisfactory
Performance:
Steps to Resolution:
Learning Resources:
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