Transcript Feedback on the Fly - University of Minnesota

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feedback
feedback
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Transition day 2014
Feedback
 A system by which some of the energy from the
output of a communications circuit is returned to
the input circuit, either to increase or reduce the
power or to regulate the quality of the signal.
 A sensory or perceptual report of the result of any
behavior which may reinforce or modify subsequent
behavior.
“Feedback is the control of a system by reinserting into
the system the results of its performance.
If the information which travels backwards from the
performance is able to change the general method and
pattern of performance, we have a process called
learning. "
–Jack Ende
Feedback
Operant conditioning?
(Type II reflexes)
What do these nice people
have in common?
All are elite, expert performers
All are elite, expert performers
who know that practice
makes perfect
In theory there is no difference
between theory and practice...
-Yogi Berra
In practice, there is.
-Yogi Berra
Expert,
Elite Performer
Does
Shows
How
Knows
How
NOVICE
Cognitive
Knows
Miller GE. Academic Med. 1990.
Expert,
Elite Performer
Does
Shows
How
Skills
Knows
How
NOVICE
Knows
Miller GE. Academic Med. 1990.
ORIME
Instructor
Manager
Ability
Interpreter
Expert/Master
Proficient
Competent
Reporter
Advanced Beginner
Observer
Novice
Dreyfus SE, 1980
The acquisition of superior performance in medicine
is closely related to engagement in practice with
feedback during medical training.”
-Ericcson, Academic Med 2004
If you don’t know
where you’re going,
you might end
up someplace else.
-Yogi Berra
Feedback can be your GPS
Patient care: Information Management-recording & presenting
Data Gathered from History and Physical Exam
•Presentations disorganized.
•Difficulty discerning amount
of detail needed. Imprecise,
Assessments not well defended
•Presentations fluent, well
organized, clinically precise
•Able to discern relevant
details while staying concise.
You can learn a lot by watching
-Yogi Berra
Feedback:
evaluation of performance
facilitates coaching
If I’ve told you once I’ve told you a
thousand times!
It’s “i” before “e” except after “c”!
Medical Math
Feedback = teaching
Feedback
SO WHAT PART OF MY INSTRUCTIONS DID
YOU NOT UNDERSTAND?!?!?
I SAID THAT’S “i” BEFORE “e”
EXCEPT AFTER “c”
What would be effective
feedback for you?
We don’t all receive feedback in the same way.
If you have received feedback that was ineffective,
why was it so?
If you received feedback that was effective, how was
it different?
For example,
The case of Millie Kablunschki
Was this feedback?
“A sensory or perceptual report of the result of any
behavior which may reinforce or modify subsequent
behavior. “
Feedback occurs when a recipient gains
insight into what they did and is instructed
in its consequences and ways to improve
Feedback in this case? The teacher said:
1. Student did not focus on the patient first
2. Student did not give pertinent findings
3. Student was reminded that vitals are always pertinent
4. Student was re-taught that a CXR cannot make a diagnosis
5. Student was informed about consequences
Was it effective feedback?
That’s up to the receiver
Do we recognize feedback?
We receive a lot of feedback every day


Learn to identify it
Learn to act on it
Most feedback is not received in formal, “sit-down”
settings
It is not personal


Our dress, behavior, speech, habits all affect how we
perform as a professional
Tone of voice, facial expression, email composition can
sometimes overshadow the message –

tune in to the message
Effective feedback should be:
1.
2.
3.
Delivered face to face
Delivered in appropriate doses
Delivered in a timely fashion
It’s all in the eyes
Effective feedback should be:
1.
2.
3.
Delivered face to face
Delivered in appropriate doses
Delivered in a timely fashion
“I must talk to you about your nose hair.”
Effective feedback should also be:
1. Specific, Concrete, Objective
 Ask for examples. Response? “vital signs need to be in every note.”
 Facts are difficult to dispute, focus on work product, i.e. patient
care
2. Professional – Respectful in voice, words, timing, location
 We are future colleagues
3. Explanatory, educational
 “Be sure to check the chart. As you learned from Mrs. Kablunschki
there is no need to order labs that have been done recently.
4. A plan for improvement
 Focus on the next step in learning, improved performance, how to
make our work/patient care better
Make sure it is specific
If student Nonny hears: “good job”
 Nonny will assume he is doing “honors” work
If Noddy hears: “good job”
 Noddy will assume she is barely keeping up
Feedback given in a stressful situation may
require repetition (and medical school is
stressful…)
 E.g. “Remember yesterday I told you that vital signs
are always pertinent so I expect you to report them on
every patient.”
What to know about giving feedback
Students also give feedback
It needs to be:
 objective, timely, professional, explanatory, and a plan for
improvement
We need to be able to trust the feedback we
receive
 Provider must be observant, competent and objective to
provide the appropriate feedback

Students must be the same
What to know about giving feedback
What to know about feedback
1. Skill development (learning) depends on getting practical
and timely feedback based on direct observation.
2. We can influence quantity and quality of feedback we get.
Take initiative and be prepared to invest in the beginning
Identify, set and share learning goals
Create opportunities for practice with observation
Schedule times for feedback
3. Pick up on the positive, catch the message in any delivery
4. Tune in and respond to feedback given
You’ve got to be very careful if you don’t know where you are
going, because you might not get there.
-Yogi Berra
What’s the point?
Keep the goal in mind – better patient care
Because it isn’t about me,
It is about how best to serve my patients
Excuse me for interrupting, but it’s
“i” before “e” except after “c.”
(Weird isn’t it?)
The ends