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Providing Constructive Feedback

Feedback is an essential part of learning and should be provided frequently. It is most helpful when it is formative—that is, when it presents information in a non-judgmental way to suggest change and improvement. (By contrast, an evaluation is summative and provides the learner with a judgment of their overall performance often in relation to their peers.) Below are some characteristics of constructive feedback.

  • Feedback should be well-timed
    • More details will be remembered if it is given at the earliest opportunity.
  • Feedback should be provided in a relaxed, supportive atmosphere
  • Feedback should first be elicited from the learner
    • Ask the learner such questions as: “How do you think that went?” “What aspects do you think were successful?" "What aspects need improvement?”
  • Feedback should be descriptive rather than judgmental or evaluative
    • Describe what was said or done, such as “The differential diagnosis was well thought out but did not include the possibility of ___” rather than “Your differential was inadequate.”
  • Feedback should focus on the behaviour rather than the person
    • “I noticed that you changed the subject when the patient started to cry” rather than “How could you ignore how the patient was feeling?”
  • Feedback should focus on observation rather than inferences
    • “Your hands were shaking” rather than “You looked nervous.”
  • Feedback should be specific rather than general
    • “You took a very thorough history of that patient’s abdominal pain” rather than “You did a good job.”
  • Feedback should be presented as a sharing of ideas and information rather than giving advice
    • “I usually approach this kind of situation this way” rather than “You should do it this way.”
  • Feedback should be limited to the amount of information the learner can use rather than the amount that you would like to give
    • Overloading a learner with feedback reduces the likelihood that the feedback will be used, and often satisfies our own needs rather than the learner’s.
  • Feedback should be directed at a behaviour the learner can do something about
  • Feedback should be verified to ensure clear communication
    • You can ask the learner to summarize what they will take from the discussion and what they plan to do (i.e. a learning plan).
Adapted from:
  • Casbergue, J. "Role of faculty development in clinical education." In: Morgan MK, Irby DM. Evaluating Clinical Competence in the Health Professions. St. Louis, MO: CV Mosby; 1978:171–186.
  • Stewart M, Brown JB, Weston W, McWhinney I, McWilliam C, Freeman T. Patient Centered Medicine: Transforming the Clinical Method, second edition. Radcliffe Medical Press Ltd. 2003: 204-207.
  • Ende J. Feedback in Clinical Medical Education. JAMA. 1983; Vol 250 (No 6): 777-781.
  • Laidlaw,T.  Characteristics of Constructive Feedback in Medical Education.

One-Minute Preceptor

Five Microskills Method

  1. Get a commitment—to the diagnosis, work-up or management plan
    • “What do you think is going on with this patient?” or “What would you recommend for this patient?” etc.
    • Promotes a feeling of responsibility for the care of the patient.
  2. Probe for supporting evidence—to promote reflection on how they came to this decision
    • “What aspects of the history and physical led you to that diagnosis?” or “Why did you choose that medication over others?” or “What else was on your differential and how did you rule those out?”
  3. Teach general rules— from what the learner has revealed a teaching point will become apparent if there are any gaps or mistakes.
    • “In situations like this, I usually …” or “Generally these tests results indicate …” or “I find this to be a useful reference for …”
  4. Reinforce what was done right—to build professional self-esteem and reinforce competencies
    • Be specific—“I noticed that you checked for drug interactions. That was a good idea” rather than “You did a good job.”
  5. Correct errors
    • Start with learner self-evaluation.
    • Consider where and when you give this feedback.
    • Frame error as “not best” rather than “bad.”
Adapted from:
  • Neher J, Gordon K, Meyer B, Stevens N.  A Five-Step “Microskills” Model of Clinical Teaching. JABFP. 1992; Vol 5(No 4): 419-24.

Feedback Grid

Continue…
  • Comment on aspects of performance that were effective.
  • Be specific and describe impact.
  • “I noticed that you considered the patient financial situation in describing that drug today.  Choosing a less costly medication will improve this patient’s compliance.”
Begin or do more…
  • Identify a behaviour the learner knows how to do, and could do more, or do more often.
  • “You should check the blood pressure before refilling the medications.”
Consider…
  • Highlight a point of growth for the learner, a “doable” challenge for future encounters.
  • “You could review the guidelines for hypertension for when the patient returns for their follow-up appointment.”
Stop or do less…
  • Describe actions that were not helpful, or could be harmful.
  • Be specific and indicate impact.
  • “You should use the correct size cuff when taking the blood pressure or you may get an inaccurate reading.”
Modified from the Coaching Feedback Format, Bayer Institute for Health Care Communication (www.bayerinstitute.org)

Source: R:\Family\Undergrad\AA -Main Directory August 2006\Preceptors\Preceptor Package\2009-2010\10.Providing Constructive Feedback.docx