Ask - Johns Hopkins Medicine

Feedback, Part 1
Learning Skills and Techniques to
Provide Meaningful Feedback
Institute for Excellence in Education
Summer Teaching Camp
Barry Solomon, MD, MPH
Thank you
Small Group Leaders
• Meredith Atkinson
• Joe Cofrancesco
• Jules Jung
• Rachel Levine
• Leah Wolfe
• Janet Serwint
“Fishbowl” Participants
• Radu Dudas
• Kristopher Kast
• Kyle Mahoney
• Tyler Mains
• Brent Pottenger
• Sarah Sunshine
The speaker and group facilitators have no financial
relationship with any commercial interest.
1. To appreciate the importance of giving
meaningful feedback to learners.
2. To understand potential barriers and
benefits to giving feedback.
3. To learn techniques and practice giving
and receiving feedback (essential
elements and Ask-Tell-Ask approach)
Session Timeline
• 8:30-8:50 - Feedback Overview
• 8:50-9:05 - “Fishbowl” Exercise
– Student Voices
• 9:10-9:45 – Feedback Practice
• 9:50-10:00 – Large Group Wrap Up
Rationale for Giving Feedback
Without feedback,
mistakes go uncorrected,
good performance is not
reinforced, and clinical
competence is achieved
empirically or, not at all.
Good behavior is
not reinforced
Learner will make
Jack Ende - Feedback in Clinical Medical Education. JAMA 1983;250:777-781.
Mistakes go
Time commitment
Failure to obtain first hand data and specific
Lack of perceived value
Previous negative experiences
Unclear performance expectations
Effects on teacher-learner relationship
Lack of training
Giving Back
To the learner
– Provides opportunity for growth
– Helps develop insight into own behavior
– Allows learner to reach self-defined goals
To the teacher
– Provides personal fulfillment
– Demonstrates interest and caring
To the profession
– Responsibility to our patients and colleagues
– Ensures the development of competent physicians
Essential Elements of Feedback
• Well timed and expected
• Teacher and learner working together with
common goals
• Based on first hand data
• Regulated in quantity
• Phrased in descriptive language, based on
specific observed behaviors
Ende J. Feedback in Clinical Medical Education. JAMA 1983;250:777-781.
The Feedback Sandwich
The New Feedback Sandwich
• Ask learner to assess own performance first
– Phrase question to encourage meaningful reflection
• What went well?
• What could have gone better?
• What were your goals?
– Make sure to allow adequate time for the answer
• Begins a conversation
• Assesses learner’s level of insight
• Promotes self-assessment and reflective practice
• React to the learner’s observation
– Feedback on self-assessment
• Tell what you observed: use specific behaviors
without judgment (positive and constructive)
Instead of…“It’s annoying when you are late.”
Try…“I noticed you have been arriving late to rounds.”
Instead of… “You need to speak up, you’re too shy.”
Try… “When I asked for your input on patient
management, you didn’t say anything.”
Ask (again)
• Ask about learner’s understanding and
strategies for improvement
What could you do differently?
– Again, give enough time
Give own suggestions
Consider replaying parts of the encounter: “show me”
• Close by committing to monitor improvement together
Small Group Practice Session
• Brief review of two tools
– Feedback Checklist & Stepwise Approach
• Practice in pairs (10 minutes then switch)
• Choose scenario that best fits your teaching role
– Clinical: Outpatient Setting
• Attending-Student or Attending-Resident
– Clinical: Inpatient Setting
• Resident-Student
– Non-Clinical Small Group Teaching Setting
• Instructor-Student
– Non-Clinical: Research/Lab Setting
• Faculty/Fellow-Student
Small Group Practice Sessions
Group 1 - Meredith/Barry, Room 370
Group 2 – Janet, Room 320
Group 3 – Leah, Room 326
Group 4 – Rachel, Room 420
Group 5 – Joe, Room 426
Group 6 – Jules, Rooms 381/382
Feedback Wrap Up
• Lessons Learned
– What went well?
– What was challenging?
• Consider “Fishbowl” as a teaching tool
• Tomorrow…
• Feedback, Part 2 - Giving Feedback and
Developing Individual Learning Plans for
Struggling Learners (Laura Hanyok, MD and

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