Presenters: Rich Lord, MD, MA; Mark Knudson, MD, MPH; Katie Watson, MD; Amanda Reavis, MD
Submission Abstract - What is this session about?
In clinical medical education, feedback refers to a process of relating specific information comparing a trainee’s observed performance in a given activity to a standard, and it is intended to improve the trainee’s future performance1,2. It is a vital “step in the acquisition of clinical skills” during residency and is essential to practice improvement for residents1,3, yet many trainees report that feedback is rare or ineffective1,2. Without effective feedback, “mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all”1.
Thus, individual feedback in Family Medicine residency programs is an important step in helping residents achieve the cognitive, affective, and psychomotor or competency objectives of the Family Medicine residency curriculum (i.e. the ACGME Milestones), and can be used for both formative and summative purposes4. Feedback, however, is only as good as what is internalized by the learner, so it is important to use principles of effective feedback with resident learners.
Effective feedback is constructive, timely, and specific1-5. It focuses on observable, remediable behaviors, and not personality traits1,2. Behaviors are compared to explicit standards1,2,5. Ideally, feedback is interactive, takes place in a relaxed, private atmosphere, and is limited to a few key points1,5. It begins with self-assessment and ends with both reflection on feedback, to aid assimilation and acceptance of feedback, and creation of a specific action plan for future improvement3-5.
At our program, we aimed to implement these effective feedback principles into an interactive, reflective resident feedback process on the Wake Forest Family Medicine inpatient service, one/a process that empowers our learners to seek feedback and rewards our evaluators for giving good feedback. After a face-to-face feedback session between each resident and attending employing the above principles and using the ACGME Milestones as reference standards, residents were asked to summarize their feedback in an action plan, which was submitted to the attending for approval and formal submission.
Why is this session important to family medicine educators?
“Making feedback a regular part of the educational experience encourages the development of expertise”5, and is an important step in helping residents achieve the cognitive, affective, and psychomotor or competency objectives of any Family Medicine residency curriculum (i.e. the ACGME Milestones). However, many trainees report that feedback is rare or ineffective1,2, and without effective feedback, “mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all”1. Thus, it is important for family medicine educators to know how to give effective feedback. In this session, we will define feedback in clinical medical education, characterize principles that make it effective, and go through a specific example of employing effective feedback principles in a new resident-faculty feedback loop process on the Wake Forest Family Medicine inpatient service, with pre-/post- resident evaluation data, so that others can take this method back to their programs. Department chair, faculty, and resident perspectives will be shared.
Learning Objectives:
First Objective: On completion of this session, the participants will be able to define feedback in a clinical education setting.
Second Objective: On completion of this session, the participants will be able to name at least three characteristics of effective feedback.
Third Objective: On completion of this session, the participants will be able to describe the implementation of an interactive, reflective resident feedback process in an academic Family Medicine inpatient service setting.
References:
1. Ende J. (1983). Feedback in clinical medical education. The Journal of the American Medical Association,250(6), 777-781. doi:10.1001/jama.1983.03340060055026.
2. Van De Ridder, J. M., Stokking, K. M., McGaghie, W. C., & Ten Cate, O. T. (2008). What Is Feedback In Clinical Education?. Medical Education, 42(2), 189-197.
3. Sargeant, J. M., Mann, K. V., Vleuten, C. P., & Metsemakers, J. F. (2009). Reflection: A Link Between Receiving And Using Assessment Feedback. Advances in Health Sciences Education, 14(3), 399-410.
4. Kern, D. E., Thomas, P. A., & Hughes, M. T. (2009). Curriculum development for medical education: a six-step approach. Baltimore, MD: Johns Hopkins University Press.
5. Krackov, S. K. (2013). Giving feedback. In J. A. Dent & R. M. Harden (Eds.), A practical guide for medical teachers (4th ed., pp. 322-332). London: Churchill Livingstone/Elsevier.