Improving teaching by teaching feedback

Abstract

Context and setting An interprofessional, international cohort of clinician educators participating in an intensive year-long faculty fellowship programme designed a group project (as part of the programme) on the skills involved in providing feedback. The outcome was a workshop that is still being presented 2 years after the programme’s end. Why the idea was necessary Reflecting on their own teaching responsibilities, the teaching scholars observed that providing feedback to learners was a communication skill essential to their effectiveness, but fraught with challenges. The group reviewed the work of others in the medical literature and in previous workshop formats, and constructed a workshop that allowed participants the opportunity to practise feedback skills. What was done A flexible-format workshop curriculum was developed. It included a didactic component on distinguishing feedback from evaluation, noting barriers and challenges to giving feedback, describing the value of giving feedback in a teaching setting and teaching the following rubric: Ask (to encourage reflection)−Tell (to give targeted feedback)−Ask (to assess understanding)−Act (to plan for future scenarios). Cases were developed to promote practise with the rubric. Small groups of participants observed while a pair within the group role-played an authentic, audience-specific feedback situation. The small group members offered their own feedback about the Ask−Tell−Ask−Act paradigm. As a large group, workshop participants discussed their initial barriers to feedback and identified those that were overcome and those that remained. The Ask−Tell−Ask−Act rubric was reinforced. Evaluation of results and impact Participants identified barriers to giving feedback, which were remarkably similar across medical specialties and professions. The most frequent barrier was the amount of time it takes to give feedback, especially in busy clinical situations. Additional barriers to feedback included a reluctance to give negative feedback, a fear of retribution for negative feedback, and a belief that feedback doesn’t influence student behaviour. By the end of the workshop, participants indicated that their reticence about giving feedback could be overcome through skills training and establishing new group norms about feedback. The innovational element of this workshop lies in its emphasis on behavioural learning by the practise of skills and focused training using scenarios relevant to the participants. Participants rated this portion of the workshop highly, regardless of their varied backgrounds (e.g. medical educators, anaesthesiologists, physician assistant faculty staff, undergraduate and graduate medical faculty in family medicine in Israel). Each group asked that more time should be devoted to role-play. There was also consensus that the simplicity of the Ask−Tell−Ask−Act rubric made it more likely they would use feedback in everyday teaching. Participants suggested that the scenarios include more specific examples about how to give negative feedback. Post-workshop evaluations were not noticeably different by specialty or between US and Israeli audiences in their acceptance of role-play and their desire to spend more time practising in small groups. Follow-up with workshop participants is planned to assess the session’s longterm impact including use of the rubric, the frequency of giving feedback and changes in perceptions of barriers to giving effective feedback.