PGY1 Pharmacy Resident
University of Maryland Medical Center
Feedback in the setting of clinical education is defined as “specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance”1. In the healthcare profession, or any area of work, improvement in performance is something everyone strives for thus, feedback is an important aspect of learning to help with this improvement. However, feedback may not always be given to the learner accurately. In fact, in a study done involving attending surgeons and surgery residents, 90.9% of attending surgeons felt they gave successful, effective feedback, however, only 16.7% of surgery residents agreed with this statement (p< 0.001).2 This discrepancy shows that giving effective and constructive feedback may be a difficult task to accomplish.
When feedback is given in an ineffective and destructive way, it can have detrimental effects. This kind of feedback is general, subjective, confrontational, contain personal judgment, contain negative reinforcement, and is domineering. It can be demotivating and result in a decrease in self-esteem in the learner. This form of feedback can also lead to the learner avoiding feedback and having hesitance to ask questions when and if they have any.3 In two studies done involving undergraduate students who received destructive criticism, students who received destructive feedback reported more anger and tension, were more likely to handle disagreements that occurred with the source of the destructive feedback in the future with avoidance or resistance (rather than compromise and collaboration), set lower goals for themselves, and reported lower self-efficacy than those who received constructive cristisms.4
In contrast, constructive, effective feedback is specific, timely, nonjudgmental, and objective. This type of feedback is more reflective, respectful, and allows there to be a safe environment for communication between the learner and teacher. Another benefit of this type of feedback is that it helps learners become more active in their learning, helping them correct gaps in their performance and motivating them to learn more in the future.3 In a cross-sectional study involving “Emergency Nursing” clinical practice, nursing students filled out a questionnaire in which they evaluated the feedback that their teachers provided. The studied showed that high quality positive feedback is associated with the students giving their teachers’ higher grades (p=0.027), students giving a “very high” evaluation to the contribution of this feedback (p=0.002), and over-self-evaluation (p=0.02). High quality negative feedback is associated with student’s having a more accurate self-evaluation (p=0.015).5 This study shows the importance and benefit of teachers giving high quality positive and negative feedback to learners.
There are many models available to help teachers give constructive, effective feedback. One such feedback model is the “Feedback Sandwich.” This type of model involves the start and end of the of the feedback session to consist of positive feedback, and the critical, negative feedback to be sandwiched in between the two positive feedback time periods. This type of feedback is more instructor focused and can lose its effectiveness if used consistently. Another feedback model is the Pendleton model. This model is more of a learner centered model in which the learner is first asked to assess themselves and answer what they think went well. After the leaner is asked how they can improve or what can be done differently. For both assessments the learner makes, the teacher reinforces the positive comments made, acknowledges the area of improvement, and helps the learner figure out a way they can improve or do things differently. After, both the teacher and learner come up with a mutually agreed upon plan.6
In conclusion, it is important for teachers to learn how to give effective feedback since the effects of giving destructive or inaccurate feedback are detrimental to the learner’s growth and emotional well-being. Providing constructive, effective feedback is extremely beneficial to help a learner improve and grow, especially in clinical practice settings for future healthcare professionals.
References:
1. van de Ridder JM, Stokking KM, McGaghie WC, ten Cate OT. What is feedback in clinical education?. Med Educ. 2008;42(2):189-197. doi:10.1111/j.1365-2923.2007.02973.x
2. Sender Liberman A, Liberman M, Steinert Y, McLeod P, Meterissian S. Surgery residents and attending surgeons have different perceptions of feedback. Med Teach. 2005;27(5):470-472. doi:10.1080/0142590500129183
3. Sarkany D, Deitte L. Providing Feedback: Practical Skills and Strategies. Acad Radiol. 2017;24(6):740-746. doi:10.1016/j.acra.2016.11.023
4. Baron RA. Negative effects of destructive criticism: impact on conflict, self-efficacy, and task performance. J Appl Psychol. 1988;73(2):199-207. doi:10.1037/0021-9010.73.2.199
5. Plakht Y, Shiyovich A, Nusbaum L, Raizer H. The association of positive and negative feedback with clinical performance, self-evaluation and practice contribution of nursing students. Nurse Educ Today. 2013;33(10):1264-1268. doi:10.1016/j.nedt.2012.07.017
6. Hardavella G, Aamli-Gaagnat A, Saad N, Rousalova I, Sreter KB. How to give and receive feedback effectively. Breathe (Sheff). 2017;13(4):327-333. doi:10.1183/20734735.009917
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