Feedback on Work-Place Based Assessment (WPBA)

Barnsley 24 May 2011

WPBA:• Case-based Discussion (CbD)• Consultation Observation Tool (COT)• Multi-Source Feedback (MSF)• Patient Satisfaction Questionnaire (PSQ)• Direct Observation of Procedural Skills (DOPS)• Clinical Supervisors Report (CSR)• Mini-CEX• ePortfolio

The importance of feedback

• Always popular with GPRs• Generic skill Education Consulting Life

• Good fit with rules of adult learning

Key principles of adult learning(RCGP Learning and Teaching Guide 2008)

1. Self direction

2. Experiential

3. Needs-based

4. Problem centred

When to use feedback

• Debriefing after clinical episodes or encounters

• Significant events: the after-discussion

• Educational review meetings: COT, CbD etc

• After any situation where the registrar has learned something

When not to use feedback

• Medical urgency

• ‘Wally’ factor

• Registrar not ready to learn

(Keep the feedback until later)

A quotation:

‘Let no day pass without discussing goodness’

Socrates – The Apology

Another quotation:

‘Seek ye first the good things of the mind, and the rest will either be supplied or its loss will not be felt’

Francis Bacon

Principles of feedback [1](Middleton and Field. The GP Trainer’s Handbook, 2001)

• Owned (‘I’ not ‘we’) NOT Implied• Planned NOT Impulsive• Honest NOT Collusive• Valid NOT Irrelevant (c.f. shared agenda)• Concerned NOT Destructive• Specific NOT Vague• Behaviour NOT Person

Principles of feedback [2]

• Observation NOT Inference• Sooner NOT Later• Descriptive NOT Judgemental• Sharing ideas NOT Giving advice• Exploring alternatives NOT Providing answers• Good things NOT Only bad things

The ‘drug’ feedback(ibid)

Feedback should be used:• At the right time• At the right dose• With clarity and accuracy• When indicated• With the registrar’s concordance• With follow-up for the registrar’s benefit

The feedback sandwich (ibid)

The meat of constructive criticism…

should be sandwiched between…

two layers of positive comment

Generic feedback models

• ALOBA (Agenda-Led Outcome-Based Analysis) 12 step approach

(Kurtz, Silverman and Draper. Teaching and learning communication skills in medicine, 2005)

• Pendleton 4 step approach(Pendleton et al. The Consultation, 1984)

ALOBA 1Organising the feedback process:• Start with the learner’s agenda• Look at the outcomes the learner is trying to

achieve• Encourage self-assessment and self problem-

solving first• In a group setting, involve the whole group in

problem solving

ALOBA 2

Giving useful feedback• Use descriptive feedback – encourage a non-

judgemental approach• Provide balanced feedback• Make suggestions rather than prescriptive

comments

ALOBA 3

Consolidating the feedback• Rehearse suggestions• Be well intentioned, valuing and supportive• In group settings, encourage others to ‘take

the spotlight’ in rehearsing skills• Opportunistically introduce theory, research

evidence and wider discussion

ALOBA 4

Summarising learning• A constructive end point is reached

Pendleton’s Rules

• Clarify matters of fact

• The registrar goes first

• Good points first

• Recommendations, not criticisms

Areas for COT/CbD feedback

• Verbal comments on criteria and assessment

• Filling in the boxes:

‘Feedback and recommendations for further development:’

‘Agreed action:’

Verbal comments

• Observe ‘rules’ of feedback• Refer to descriptors• Justify grading, in particular:

If ‘Excellent’ explain whyIf ‘Needs further development’ explain why, and

recommendations for future development[if you don’t have ideas for future improvement, it isn't NFD]

Feedback and recommendations

• Thumbnail of case. Computer number

• Evidence to justify ‘E’ or ‘NFD’

• Recommendations (how many?) – phrased as Aims

Agreed action

• Maximum of 2 (? - discuss)

• Phrased as Learning Objectives: SMART

• Transfer to PDP

• Checking achievement

Key Points

• It is not possible to give your GPStR too much feedback

• Try and think of something nice to say before putting the boot in

• If putting the boot in, criticise the behaviour not the person

• ALOBA is more impressive, but Pendleton is more practical

Take-home Message

You too were once an ignorant incompetent GPStR….

…and just look at you now.

Your mission (should you choose to accept it…)

• Individually decide on grades, and why• Small groups:

Share your grades and your reasonsDiscuss content of verbal feedbackWhat will you put in the ‘Feedback and

recommendations box?What will you suggest for the ‘Agreed action’ box?

• Plenary