This essential part of the learning cycle is necessary to correct mistakes, change behavior, or continue good performance. When you describe specific behavior around the knowledge, skills, and attitudes you want the learner to gain, you provide information about his or her current performance in a way that will guide future learning and performance. Without this feedback, the learner may assume that he or she is performing adequately.
It Takes Two
As with any form of communication, feedback requires a ‘giver’ to provide information and a ‘receiver’ to take in that information. These roles may oscillate during an interaction, but there is always a give and take between at least two parties. By definition feedback will always be more about the giver than the receiver; a giver can only describe his or her perceptions based on personal experience. It is important to remember that the receiver has a choice about what to do with the feedback.
Faculty often say that they give plenty of feedback during a rotation or course. Yet, learners often note that they do not receive enough feedback. This disconnect between faculty and learner perceptions can be remedied by labeling an interaction as “feedback” when you start and finish the discussion. Open the discussion by asking, “May I give you some feedback?” This labels the interaction and makes sure the receiver is ready to hear feedback.
Four Components of Feedback
Content, or what you say, should focus on specific and concrete behaviors. By keeping the content centered on the issue, you avoid making it personal. Include positive content about behaviors the receiver should continue and corrective content about behaviors that need to change or improve. Always try to relate your content to the learning objectives, and limit corrective feedback to two or three items at a time.
Manner, or how you say it, will affect the receiver’s receptivity to and valuation of your feedback. Avoid judgmental or emotional comments. When either the giver or receiver is angry or frustrated, corrective feedback should be delayed if possible until it can be delivered in a constructive way.
Timing, or when you say it, should be as close to the class session or clinical scenario as possible, so ASAP. However, negative or corrective feedback should be given as soon as reasonable, so ASAR. Use your best judgement about when to give corrective feedback until you can assure that the discussion will focus on concrete behaviors instead of emotional reactions and that the receiver will be receptive.
Frequency, or how often you say it, is also important. Learners crave feedback, so offer feedback as often as possible. Even though instructors often feel like they give ample feedback, learners regularly report not getting enough. Try leading with “May I give you some feedback?” to draw attention to the fact that you will be doing so. When given often, the feedback process is normalized for the receiver.
Models for Delivering Feedback
This model for giving feedback begins by asking the receiver to reflect on and self-assess their performance. The giver then tells what they observed, either validating or adding to the self-assessment, and provides concrete instruction for change. The giver then asks the receiver to confirm understanding. This question sequence may be, “How do you think you performed in that encounter?” followed by behavioral observations and suggested improvements to those behaviors, followed by “Do you understand or have questions about the feedback you just received?”
Feedback “Wrap” vs. Feedback “Sandwich”
Some faculty are in the habit of sandwiching a critique between two compliments. This leads the learner to hear the criticism but miss the compliments. Consider instead using a feedback “wrap” by weaving together possible improvements and positive feedback together. Used effectively during a formal feedback meeting, the “wrap” allows the giver and receiver to collaboratively construct an improvement plan.
This model summarizes the qualities of effective feedback as Balanced, Observed, Objective, Specific, Timely. Feedback should include growth opportunities and strengths, be based on direct observations, lack judgement statements, be supported by specific behavioral examples, and be discussed as close to the encounter as possible.
Stop, Start, Continue
This type of feedback outlines behavior that is not working (what to stop doing), how to improve that behavior (what to start doing), and what is working (what to continue doing). The flexibility and simplicity of this model is helpful; it can be used informally or formally, verbally or by email, peer-to-peer or faculty to learner.
- What Did You Say? The Art of Giving and Receiving Feedback (Seashore, Seashore, & Weinberg, 2002)
- Fostering Reflection and Providing Feedback: Helping Others Learn from Experience (Westberg & Jason, 2001)
- Twelve Tips for Making the Best Use of Feedback (Van Der Leeuw & Slootweg, 2013)
- Giving Feedback (Thomas & Arnold, 2011)
- Communication and Deliberate Feedback (Carter, 2013)
Seminal articles on feedback:
- Feedback in Clinical Medical Education (Ende, 1983)
- Giving Feedback in Medical Education Mariana Hewson (Hewson and Little, 1998)