Providing Feedback

Feedback is an essential component of education. It is designed to influence, reinforce, and change behaviors, concepts, and attitudes in learners. Although providing constructive feedback can be challenging, it is a learnable skill. The negative consequences of destructive feedback or lack of feedback all together are far-reaching. This article summarizes the components of constructive feedback and provides readers with tangible skills to enhance their ability to give effective feedback to learners and peers.

Introduction

Whether in the world of business, education, or clinical practice, feedback is an essential component to the development of the recipient. Feedback is designed to influence, reinforce, and change behaviors, concepts, and attitudes . It involves sharing information with the recipient for the purpose of narrowing a performance gap. In fact, some may argue that it is the cornerstone of education . A world without feedback would lead to unabated poor performance, lack of reinforcement of good performance, and essentially no path to improvement . Many publications and discussions have focused on feedback, yet providing effective feedback remains a challenge for many academicians. The goal of this article is to present practical skills and strategies for providing feedback to learners and peers.

Assessment and Feedback

A discussion of feedback requires a brief discourse on assessment and how these two concepts are related. Within the context of education, assessment steers learning and has considerable potential to influence a student’s personal motivation and overall learning experience . In the formal education lexicon, assessment is described as formative versus summative. Formative assessment is best characterized as “assessment for learning” and summative assessment as “assessment of learning.” What is “assessment for learning” or formative assessment? Simply put, it is an assessment of what the learner knows, understands, or can do during the learning activity. This information is then used to provide feedback throughout the activity, with the goal of improvement. For example, Dr. Richardson did not administer epinephrine during the simulation of a severe contrast reaction—why didn’t she, and how can we help her improve her performance during the next simulation? “Assessment of learning,” or summative assessment, evaluates whether the learner knows, understands, or is able to successfully complete a predetermined activity. A summative assessment occurs at the conclusion of the learning activity with the goal of assessing whether the recipient has met performance expectations or standards . In this context, a summative assessment constitutes a higher stakes judgment of the student’s performance or credentials . For example, is Dr. Smith a board-certified physician or not? (see Table 1 for a summary of formative versus summative assessment).

TABLE 1

Formative Versus Summative Assessment

Formative Assessment Summative Assessment Throughout training period End of the training period Frequent Infrequent Low stakes—suggestions for improvement on central line placement or positive reinforcement of high level of professionalism High stakes—standardized exam scores such as MCAT, STEP 1, ABR Core, and certifying examination Share information about performance between student and teacher Confer judgment in the form of grades, degree, and certification Relatively time-consuming for the teacher Quicker approach to assessment by an institution

ABR, American Board of Radiology Core Exam and Certifying Exam; MCAT, Medical College Admission Test; STEP 1, United States Medical Licensing Exam Step 1.

In summary, formative assessments inform the student (in the previous case, physician) about his or her performance with guidance on how to improve, whereas summative assessments educate the public and other stakeholders about whether a potential provider is qualified versus unqualified, or even a false representative of the healthcare field .

Although formative and summative assessments have differentiating features, a blurring of this line can occur with feedback. Based on the preceding description of assessment, the term “feedback” seems more closely aligned with formative assessment; however, feedback can also occur with summative assessment. For example, consider a first-year radiology resident who scores 10th percentile on the American College of Radiology (ACR) in-training examination. Although this score constitutes a summative assessment of this resident’s performance compared to all other first-year residents, this information can also be used to provide formative feedback to the resident, with a goal of improved performance on future examinations. Therefore, it serves not only to “judge” the resident’s performance compared to peers, but also to provide information which can be shared and reflected upon . Alternatively, conventional formative assessments are sometimes used in a summative manner. For example, consider the radiology resident portfolio. Documented data may include ACR in-training and American Board of Radiology (ABR) Core examination results, procedure logs, rotation evaluations, peer and self-evaluations, progress toward milestone achievement, and scholarly and quality projects. In some situations, portfolio data may be used for a summative approach to advancement .

Frames and Perception of Feedback

Get Radiology Tree app to read full this article<

Destructive Versus Constructive Feedback

Get Radiology Tree app to read full this article<

Feedback Scenarios

Scenario 1

Get Radiology Tree app to read full this article<

Issue 1

Get Radiology Tree app to read full this article<

Dr. Alvarez: John, I hope you don’t mind, but Josie, my administrative assistant, will be present to take minutes. I received a call from the Emergency Medicine Chairwoman. She told me that you were combative on the phone with two of her Physician Assistants (PAs) on Saturday.

Get Radiology Tree app to read full this article<

Issue 2

Get Radiology Tree app to read full this article<

John: I am not sure what you mean? Saturday was busy, but I always try to be professional. Dr. Alvarez: I was told that you were rude to Physician Assistants Lisa and Mark regarding their questions about contrast and a pelvic ultrasound read. John, you should know better, and I expect more from a senior resident. How many times have I told the residents that we are a referral service, and that it is extremely important to keep our referrers happy! I have always kept our residents in mind when making decisions, but to be honest with you, this is just embarrassing. I can’t have this; I am a respected chairman in this hospital. I expect you to apologize to each of the Physician Assistants immediately if you want to continue your residency training here.

Get Radiology Tree app to read full this article<

Issue 3

Get Radiology Tree app to read full this article<

Scenario 2

Get Radiology Tree app to read full this article<

Dr. Ragesh: Kurt, what were you doing fumbling around that crash cart? Time is of the essence, your indecisive behavior cost the patient their life. Can anyone tell me Kurt’s critical mistake?

Get Radiology Tree app to read full this article<

Issues

Get Radiology Tree app to read full this article<

1. Get Radiology Tree app to read full this article<

Get Radiology Tree app to read full this article<

Scenario 3

Get Radiology Tree app to read full this article<

Issues

Get Radiology Tree app to read full this article<

Dr. Philipov: Sheila, thanks for coming to my office on short notice. Call is quickly approaching, and I want to let you know the CCC loves your enthusiasm, and team-player approach. However, the CCC consensus is that your diagnostic skills are a little behind your peers, prompting a decision to delay your first call by one month to help get you up to speed. This is really no big deal and I want you to understand that you have done nothing wrong. On the contrary you continue to impress the faculty. Keep up the good work. Sheila: But, Dr. Philipov, no one has ever mentioned anything about being behind. I don’t understand, what specifically do I need to do to improve? Dr. Philipov: It is nothing in particular; we just want you to see more cases before call.

Get Radiology Tree app to read full this article<

Issues

Get Radiology Tree app to read full this article<

Scenario 4

Get Radiology Tree app to read full this article<

Issues

Get Radiology Tree app to read full this article<

Feedback Techniques

Get Radiology Tree app to read full this article<

Establishing a Feedback Culture

Get Radiology Tree app to read full this article<