FEEDBACK AND REMEDIATION Garry Sigman, M.D. Associate Professor, Pediatrics Chairman Student Progress Committee SSOM DEFINITIONS Feedback: An informed, non-evaluative, objective appraisal of performance intended to improve skills Ende, 1983 Remediation 1. (Medicine) affording a remedy; curative 2. (Social Science / Education) denoting or relating to special teaching, teaching methods, or material for backward and slow learners remedial education
Feedback: Micro-remediations- frequent, short encounters with students Remediation: Methods of correcting problems in students who are performing poorly MODERN MEDICAL TRAINING AFTER HAUER, 2010 Clinical Training Assessment of Competence Feedback Experience Feedback
Experience Advance to next level Remediation THE FEEDBACK SANDWICH Positive complement Constructive criticism Positive complement PENDLETONS RULES
The learner goes first and performs the activity The learner then says what they thought was done well The teacher then says what they thought was done well The learner then says what was not done so well, and could be improved upon The teacher then says what was not done so well and suggests ways for improvements, with discussion in a helpful and constructive manner
PROPER AND IMPROPER TECHNIQUES FOR PROVIDING FEEDBACK Proper Based on direct observation Respectful and supportive Sensitive Non-judgmental Focus on behavior Focus on specifics Goal-based Thoughts and feelings of learner sought Suggestions for improvement After Hewson, Little, 1998 Improper Based on hearsay Disrespectful, antagonistic
Insensitive Judgmental Focus on personality Focus on generalities Not goal-based Not sought or considered No suggestions for improvement PROBLEMS WITH TRADITIONAL FEEDBACK Imbedded in hierarchical endeavors of health professionals; educator driven one-way analysis Reductionist
Formulaic nature is easy to become banal and unbelieved Does not incorporate psychosocial characteristics of learners PROBLEMS WITH TRADITIONAL FEEDBACK Traditional sandwich method- as soon as learner hears praise waits for criticism Difficult to maintain positive emotional state
Incompetency attacks: negative emotional states can dominate interchange and can linger LEARNER ISSUES WITH FEEDBACK Self-assessment is not strongly validated; behavior and performance informed by unconscious mind focused on self-preservation Recipients of negative feedback blame external factors and reject personal responsibility Learners with high emotional stability, high levels of
responsibility, and high sociability more likely to be motivated by feedback Sargeant, 2006- in intervention group, those who received negative feedback often responded negatively, and behaved as if feedback to be obstructive to change Poor feedback cause learner to believe that it was useless, burdensome, critical or controlling. THE NET GENERATIONCHARACTERISTICS Freedom Customization
Scrutiny Integrity Collaboration Acceptance Entertainment
Speed Innovation Expression AGENDA LED- OUTCOMES BASED ANALYSIS ALOBA Example: Start with trainees agenda
Look at short term outcome Encourage self-assessment and problem solving Suggest alternatives No negative feedback statements; make overall positive comment about performance REMEDIATION Implies remedy
Remedy implies diagnosis Diagnosis is best self-discovered UTILIZING A MOTIVATIONAL INTERVIEWING APPROACH TO MACRO-REMEDIATION FRAMES F- Feedback (From course, clerkship Grade and Summation) R- Responsibility
A- Advice (from selfReflection) M- Menu of options E- Empathy S- Self-efficacy MODEL OF REMEDIATION PROGRAM Mulitimodal assessment Mentoring
Coaching Diagnosis of deficiency Develop individualized plan for learning Instruction, practice, feedback, reflection Reassessment Hauer, et al, 2009 REMEDIATION BASED UPON DEFICITS Knowledge deficits
Knowledge and skills deficits Help build knowledge base Professionalism/ interpersonal deficits Above and practice with feedback Feedback, instruction, reflection, observation and interaction
REMEDIATION IN MEDICAL EDUCATION Little evidence for best practices Small number of studies indicate: Multi-assessment tools Individualized instruction
Practice-feedback-reflectionreassment Bibliography: Feedback and Remediation Archer J. State of the science in health professional education: effective feedback. Med Educ 2010:14:101-108. Ende J. "Feedback in clinical medical education. JAMA 1983;250:777-781 Hauer KE, et al. Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature. Acad Med 2009;1822-1832. Hewson M, Little M. Giving feedback in medical education. J Gen Intern Med 1998;13:111-116. Turner T, Palazzi D, Ward M. The Clinical Educators Handbook. Ch. 17. Baylor College of Medicine: 201-212.
