10-6 YES!: Improving Verbal Feedback

October 06, 2023

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00:00And push the button.
00:11Thanks, Ed. So I think we'll get started.
00:16Welcome to the Yale Medical Education Series.
00:19It's yes, for short.
00:20We took a little bit of time
00:22trying to think of a great acronym.
00:24So leaving the M Out and Yale
00:27Medical Education series, yes,
00:29it's sponsored by the Center for
00:32Medical Education, of which I'm a part.
00:35And the series is directed by
00:37Doctors Dana Dunn and Andres Martin.
00:40Doctor Martin will also be you'll be
00:41hearing from him a little bit because he'll
00:44be moderating the discussion in a bit.
00:45And both are faculty associates
00:48at the center today.
00:49We have two skillfully
00:51wonderful educators with us.
00:53Doctor Susan Kashoff is a longtime partner
00:56and a colleague in Yale Medical education.
00:59She's an adult primary care physician.
01:02She's associate professor of medicine and,
01:04importantly, a student advisor through
01:07the Office of Student Affairs.
01:09Based at the VA Primary Care Clinic.
01:12Her educational contributions are many.
01:14They've included teaching medical
01:16students on topics like problem focus,
01:19patient exams, issues of professionalism,
01:23clinician responses to intimate
01:25partner violence, and many,
01:28many more.
01:29Joining her is doctor Uma Patak,
01:32who's a pediatrician,
01:34associate professor of Pediatrics,
01:36and director of the pediatric component
01:38of the Women's and Children's
01:41Health Integrated Clerkship,
01:42A mouthful.
01:44She's also a director of the Pediatric
01:48Gastroenterology,
01:48Hepatology and Nutrition Fellowship,
01:50an alumni of the Center's Medical
01:53Education Pathway Masters Program.
01:56Her thesis in that program was
01:58on today's topic,
02:00improving feedback and medical education,
02:02so you'll be hearing some rich things from
02:06her that stem from her thesis and beyond.
02:09Both Uma and Susan are alumni
02:12of Yale GME Training Program.
02:14Zuma did her fellowship and Susan her
02:17residency at Yale New Haven Hospital.
02:19So they've been around a while.
02:21And both were clinical assessment
02:23coaches in the pilot program to
02:26what's now called the Longitudinal
02:28Coaching Program for Medical Students,
02:30which is currently in its inaugural year.
02:33So at some point we can talk
02:35about all these things.
02:36If not today,
02:37they're all important things
02:39that are happening at Yale.
02:41So both Susan and Uma have lots
02:43to teach us about feedback.
02:46So it is with great gratitude that
02:48I handed over to the two of them.
02:53Great. Well, welcome everyone.
02:55I'm going to share my screen.
02:58Thank you very much for spending
03:00your lunch hour with us talking
03:03about this important topic.
03:05And there we go away from start.
03:08OK. So today we're going to be
03:11talking about verbal feedback.
03:13Specifically,
03:14there is a session coming up
03:16on written feedback in January,
03:18and we're going to build on the
03:21previous sessions on Learning Climate.
03:24So I think you've seen this,
03:25but to record your participation,
03:27you can text your attendance to that number.
03:31And we'd like to acknowledge the A/C
03:34Zone with Faculty Development Toolkit,
03:36which is a fantastic resource.
03:38I'd encourage you to take a look
03:39at and also Walter Kernan for a
03:42video that we're going to use
03:43to practice the skills together.
03:47So education without feedback.
03:50We've created a safe,
03:51nonjudgmental environment that will leave
03:53your child ill prepared for real life,
03:55and I would argue that it is
03:58the same for our trainees.
04:00We give education without feedback,
04:03so our goals today are to start by
04:06discussing what makes for useful feedback,
04:09describe some barriers to feedback,
04:12and learn and practice a model
04:14of feedback together.
04:18So what defines constructive feedback?
04:21There are a few articles from ND,
04:24who's the father of feedback in medicine,
04:26which articulate the principles
04:28of effective feedback.
04:30And interestingly,
04:30when looking at the feedback literature,
04:33a lot of it is in teaching,
04:35in business, and in coaching.
04:37But it's really the same basic
04:40principles that come up again and again.
04:42So perhaps most importantly,
04:44constructive feedback needs to be well
04:48intended and based on shared goals.
04:51So this really builds off of that
04:53positive learning climate that
04:54we've talked about before and
04:56that learning climate needs to be
04:58established early and reinforced
05:00throughout the rotation month, year,
05:03however long you have with that learner.
05:05So that that learner really believes
05:07that the feedback is for their benefit
05:10and is based on the fact that you care
05:12about their professional development.
05:15So effective feedback is
05:17behavior or performance based,
05:20is directly observed based on firsthand
05:23information as opposed to hearsay,
05:25and is specific enough so that the IT can
05:30be useful but also needs to be manageable.
05:32So giving someone a lot of feedback
05:35points might make it overwhelming.
05:37It also needs to be within the
05:39realm of what can be changed and
05:42ideally it should be timely or
05:44close to the time of observation.
05:47So there are a lot of barriers to feedback.
05:49We'll talk about some of them and but
05:51really in the feedback equation there
05:53are three factors that are important,
05:54the teacher,
05:55the learner and their environment.
05:57So we're going to talk about each of those
06:00factors and what barriers there are and
06:02what opportunities they can represent.
06:04So what gets in the way of feedback
06:06at the level of the teacher?
06:08There are competing demands,
06:10so when I'm listening to my medical
06:13student presenting the patient on rounds,
06:17I'm also listening to what is happening
06:20with the patient and trying to do the
06:23clinical care around that patient.
06:25There are time and space constraints,
06:27so maybe I'm walking into the patient room.
06:30Maybe that student or night resident is
06:34leaving because duty hours are being met.
06:38There's variable amounts of
06:39training so we can all have some
06:41discomfort around giving feedback.
06:43Hopefully we can address that
06:45today and it's really hard to do.
06:48It's uncomfortable to give,
06:50especially what can be
06:52seen as negative feedback,
06:53and there can be an emotional
06:56reaction in both parties.
06:57And finally,
07:00there can be a fear of retaliation,
07:01which is sometimes well founded.
07:04Negative about negative feedback
07:05can have adverse consequences to
07:07the faculty member that's giving it
07:08and that could just be extra work
07:10and trying to work through through
07:12that with the person or stress.
07:14I mean I have been up at night thinking
07:17about the the challenging feedback
07:19I'm going to give to someone or even
07:23retaliation in the form of evaluations
07:26that are negative of of us as the
07:30educator at the level of the learner.
07:31There are also barriers
07:33to getting that feedback,
07:35to accepting that feedback and
07:38to incorporating that feedback.
07:40So first of all,
07:41we're really bad at assessing ourselves.
07:4493% of American drivers
07:46think they're above average.
07:47I am among the 7% who knows I am
07:51below average as a driver also.
07:53It's interesting and I'm
07:54sure you've seen this,
07:55that sometimes the lower performing
07:58residents don't readily identify
07:59their weaknesses and actually
08:01can overestimate their abilities,
08:03while the higher performing
08:05residents can underestimate their
08:07skills in core competency areas.
08:10And interestingly,
08:11we all think that we're better at
08:14self-assessment than we are and better
08:16than others at assessing our needs.
08:18So Kevin Ava,
08:20who is a leader in this in this area,
08:23calls that the they not we phenomenon.
08:25And finally,
08:26even if we're fully aware of our weaknesses,
08:28we're often afraid to reveal
08:30those weaknesses to the person
08:31who's going to be grading us.
08:33So that's the coach versus judge phenomenon.
08:35So when the person that's teaching
08:39someone is also the person that's
08:41assessing them and determining
08:43their future opportunities,
08:44that can be stressful as opposed
08:46to a coach who's really there just
08:49to help improve clinical skills.
08:51The judge is responsible for
08:53assessing that trainee's performance.
08:55And as clinical supervisors,
08:56we have that dual role which can
08:59make the the trainee less likely
09:01to reveal their weaknesses even
09:03if they are aware of them.
09:05And finally,
09:06there are different types of
09:09learner goal orientation,
09:11so there can be performance oriented.
09:13So like the goal is to look smart
09:15or learning oriented where the goal
09:17is to improve and our environment
09:19which is really achievement based
09:21and high stakes and competitive at
09:23times may induce more of a performance
09:26goal orientation which can lead to
09:28avoidance of that essential feedback.
09:30So really trying to foster that
09:33growth or learning mindset can
09:34increase the receptivity to feedback
09:37and feedback seeking behavior and
09:39support the development of mastery.
09:43There are also systems barriers to feedback
09:47in addition to the teacher and the
09:49learner in terms of the learning culture.
09:50So in addition to the lack of time that we
09:53talked about and competing priorities and
09:55variable amount of training and discomfort.
09:57There is now even less continuity and
10:00and fewer opportunities to observe and
10:03assess our learners with the tending
10:05blocks as short as one or two weeks and
10:08constant turnover of trainees and and and
10:12educators often mismatched with each other.
10:16So there's also a hidden
10:18curriculum in medicine.
10:19A pressure to perform a fake
10:20it till you make it mentality.
10:22That and the need to not appear incompetent.
10:24Again because of our achievement based
10:27high stakes competitive environment
10:29that can make us hesitant to seek
10:31feedback that can be negative
10:35even when we're giving feedback.
10:37Often some of the problem is that it might
10:39be mismatched with what our learning is.
10:42Learner is asking for is there's a great
10:44book called Thanks for the Feedback and
10:47they categorize the types of feedback,
10:51all of which are essential into 3 categories.
10:53So appreciation which is recognition,
10:56motivation and thanks.
10:57It helps you know that your efforts are
10:59noticed and makes you feel worth a lot.
11:02Coaching which is more help.
11:04It helped aimed at helping you improve,
11:06learn, grow and change either to meet new
11:09challenges or to correct an existing problem.
11:11And then evaluation,
11:12which is really assessment.
11:14It tells you where you stand in relation
11:16to expectations and to other people,
11:17and it helps align expectations between
11:20people and clarify consequences.
11:22So if we're giving someone feedback,
11:25that is appreciation.
11:26But what they're really wondering is,
11:28am I on par with my peers?
11:30Am I on track for promotion and graduation?
11:32That can be unsatisfying to that person.
11:36I'm sure you've all been in the situation
11:38where you're giving someone feedback
11:40and they, you know, they're like,
11:42waiting for the shoe to drop.
11:44They're waiting for that feedback sandwich.
11:45You say something nice,
11:46you're going to say something that's,
11:48you know,
11:49negative and then say something nice again.
11:51And I've actually had people like,
11:53where's the middle of the sandwich?
11:54Like,
11:54where are you going to tell me the things?
11:56Is there something you're not telling me
11:59or you are giving them again appreciation,
12:03but they're really looking for coaching.
12:05So what it is that they can do better.
12:09So the implications of that lack
12:12of effective feedback are many.
12:14So there can be missed
12:15learning opportunities,
12:16there can be learner and security
12:18and feeling like they're just being
12:20praised or passed along without really
12:22knowing what they can be better at.
12:24We can have inaccurate perception
12:25of performance by the learner.
12:27So they think they're doing great
12:29or they think they're doing poorly
12:31without really knowing what what their,
12:35what their educators,
12:36what their teachers think.
12:38And there can be a performance
12:40plateau and we're no longer
12:41coaching people for improvement.
12:42And finally there can be disappointment
12:44surprised with final evaluations.
12:46So as an advisor,
12:47I see this often where people have
12:49not been told the things that that
12:50they could be doing better and then
12:52they get their final evaluation
12:54and that's surprising to them and
12:56they haven't had the opportunity to
12:58to really talk about those things.
13:01So I'm going to pass this along
13:04to Doctor Fattock to talk about
13:05a way of doing this better.
13:09Thanks Susan, and thank you,
13:10John for that kind introduction
13:12and the organizers for the
13:14opportunity to speak today.
13:16Really excited to talk on an
13:18important topic of feedback.
13:20And Susan just gave you the background
13:23in terms of the importance of
13:26feedback conversations as well as
13:28what the barriers we all encounter
13:31in our daytoday lives in having
13:33these type of conversations.
13:35So now we'll switch gears a little bit
13:37and talk about in the next few slides,
13:40an interactive model of giving back that
13:43all of you will utilize in practice
13:46when you go into breakout rooms and
13:49the end of that section of our talk,
13:52because really a large part of feedback
13:54is practicing how to get better at it.
13:58Before we start feedback
14:00conversations though,
14:01it's really important to set the stage
14:04for those feedback conversations and
14:06it's extremely important to normalize
14:09feedback and we cannot highlight
14:11the importance of spending time in
14:14this piece of feedback before you
14:17actually launch into that conversation.
14:20So as Susan mentioned,
14:22the learning climate is extremely important.
14:24So when we're preparing to
14:26give feedback to our trainees,
14:28it's important to promote relationships,
14:31important to really spend time building
14:34and fostering a warm learning climate.
14:37Establishing goals as Susan mentioned,
14:40not necessarily just performance
14:43focused goals,
14:44but perhaps mastery goals is
14:47also important and having them
14:50be small achievable goals is can
14:53sometimes be more impactful.
14:55It's also helpful to think about
14:57the setting when where this
14:59conversation is going to happen.
15:01We're often in busy clinical settings and
15:04it's difficult for us to really find space,
15:07but but spending some time and
15:09thinking about that might be helpful.
15:12And the the last point is I think
15:13we've all been there, right?
15:15We've,
15:15we've given feedback to our trainees and
15:18we've felt like we've given feedback.
15:21But a lot of times when our trainees
15:24complete evaluations or are asked about it,
15:26they feel like they've not
15:28received feedback from us.
15:30So it's really important to signpost it.
15:33So before you start that feedback dialogue,
15:36it's helpful to say, OK,
15:38now I'm going to give you feedback,
15:40so don't hesitate to use
15:42that eight letter F word.
15:48So why are goals important?
15:50Because we all need to have a
15:53shared mental model of what our
15:55conversation is going to be about.
15:58So I I love this, this cartoon
16:00that I will let all of you read.
16:03But it's it's really important that we
16:06set goals such that the trainee feels
16:08like they're being heard as well as
16:11we're giving them feedback on exactly
16:13what they're looking for feedback on.
16:16So setting goals is a shared
16:19process where we discuss and come
16:22up with some set goals and you can
16:25ask about goals utilizing Susan.
16:28If you could please press the next button.
16:32Questions such as what do you
16:34hope to get out of this rotation.
16:36Sometimes you might need to be a
16:38little bit more directive and say
16:40my goals for your week on X are and
16:43then we could work together on those
16:45or what are you working on that
16:47you want to continue to work on.
16:49So these are some of the ways
16:51you can help to set goals.
16:55So next we'll talk about
16:57an interactive model,
16:59a learner focused model of giving feedback,
17:02which is called the Adapt model.
17:03And this is just one of many
17:06models of giving feedback.
17:08What we like the specific model
17:13because of that initial asks ask
17:17which helps to helps the feedback
17:20ever understand the insight of the
17:23person who's receiving the feedback.
17:24So the adapt model stands for
17:27the first A is ask, discuss,
17:30ask and plan together.
17:33So the first ask
17:38is, is where you assess for
17:43insight for learner insight.
17:46And I think Susan talked about this and
17:49that as physicians there's abundance
17:51of literature to suggest that we're
17:54not very accurate at self-assessment
17:56and same with our learners.
17:58So it's important to ask them what they
18:01feel their performance was like or
18:04how they felt they did and it really
18:07can help you tailor your feedback
18:10conversation to that learner perception.
18:12So examples of asking for that initial
18:15ask are how do you think that when
18:18or how do you think things are going?
18:21You can hone in directly on what's
18:23going well.
18:23So you could say what's going well,
18:24what went well,
18:25or you could ask them what may
18:28not have gone so well.
18:30Or you could be very specific
18:31and just directly ask them what
18:33do you want feedback on.
18:34So these are some ways of making
18:37sure you ask about that first.
18:41Ask Once you have done that,
18:43the next step for the next D in the ADAPT
18:47model is to discuss your observations.
18:49And I just want to again
18:51highlight the word observations.
18:52So you're being a behavioral
18:55diagnostician and you're describing
18:58what you have observed and your
19:00observation should include some
19:02positive and reinforcing comments,
19:04should include some corrective comments.
19:07They should be very specific
19:09though to that shared goal that you
19:12came up with that at the outset.
19:14A lot of times we have a lot to
19:17say and our trainees might get
19:19overwhelmed with all of the information
19:21that we provide them.
19:22So it's important that we monitor and
19:25control our our discussions such that
19:29we've prioritized our discussions
19:31to maybe two or three observations
19:33about our trainees so that they
19:35can digest it and our feedback
19:37is a little bit more impactful.
19:41Our tone matters.
19:44The content matters, and it's important
19:47to be descriptive and not interpretive.
19:49So, for example, it's not okay to
19:52say that your history was inadequate,
19:54but it is okay to say that,
19:57you know, as I was observing you,
19:58I noticed that you omitted a
20:00few key parts of the history
20:02and then described those parts.
20:04To your learner.
20:05So here we're talking about their
20:07behavior or their performance,
20:09but we're not talking about them so
20:12that it's not a judgmental conversation.
20:17The next ask clarifies what the learner
20:21took away from that conversation
20:23that you had or the feedback
20:25dialogue that you had with them.
20:27And here you're asking them for
20:30opportunities for change and for development.
20:34And here you can get a sense of
20:37understanding of how receptive was your
20:39learner to the feedback you just gave them.
20:42So you could elicit this ask by
20:44questions such as what are your thoughts
20:46about that or does that make sense,
20:48anything that stuck you as some
20:51struck as something to work on?
20:56And then the last part
20:58of our adapt model is the plan together.
21:03I will say that oftentimes this is
21:04one of the forgotten pieces of the
21:07feedback conversation where all of us
21:09are good at at having that conversation,
21:11but then we sometimes might forget
21:14actual tangible steps to come
21:17up with for improvement.
21:18So here the plan together is such
21:21that you're trying to get the
21:24learner from point A to point B.
21:26So you're you're coming up with certain
21:28ways for them to improve strategies that
21:32they can work on and the action plan can.
21:35You can ask them questions such as
21:37how might you work on X or who or
21:40what might help you with this change,
21:42what might get in the way.
21:43Because oftentimes there might be
21:45barriers to bringing about change
21:47and and trying to work on those
21:50might be most impactful.
21:52Or you can again be a little bit
21:53more directive in that learner
21:54who needs that extra help,
21:56where coaching might not be the
21:58greatest but rather advising might
22:00be more helpful where you can say,
22:01OK, here are my suggestions to
22:04you for your action plan and let's
22:07see you work on these.
22:10So that is the ADAPT model.
22:13And
22:16Susan, if you could just go,
22:19essentially this is a handout
22:21of the ADAPT model that we will
22:25plug in the chat really quickly.
22:28We are going to go into breakout
22:31rooms to practice using ADAPT
22:34model and this little handout we
22:37hope will be helpful to you to
22:40go through the steps of ADAPT.
22:47All right. So does everybody feel ready to
22:51practice using the ADAPT model, following
22:54that little description of the ADAPT?
22:59So here's what we're going to do.
23:00We're going to have you all go into breakout
23:03rooms for a duration of 15 minutes and
23:06we'll have three people in a breakout room.
23:09We're asking one of you to
23:12be the giver of feedback,
23:14a second person to receive feedback,
23:17and a third person to be the observer
23:20who observes the feedback conversation.
23:22And also that person will be the observer,
23:25will be the one giving feedback
23:28on the feedback.
23:29So we'll have you do that
23:31after watching this video,
23:32which we will show you shortly.
23:35And in the video,
23:36you will see a medical student.
23:38You'll see an attending who's
23:40observing in that video.
23:42And then you'll see the
23:44patient and his partner,
23:47the shared goal that the teacher
23:50and the student have come up with
23:52for the purposes of feedback.
23:53Conversation is shared decision making.
23:56So as you watched the video,
23:58use the handout that we just
24:01posted in the chat.
24:03Think about what reinforcing or positive
24:07comments you might give the student.
24:10Think of yourself as the attending.
24:12Think about what constructive
24:14comments you might give the student.
24:17And then for those who might
24:19eventually in the breakout rooms
24:21with the giver of feedback,
24:23utilize that handout,
24:24the adapt handout to go through all of the
24:28steps and give feedback to the learner.
24:30So one person will play the role
24:31of the attending,
24:32who's the feedback giver,
24:34the second will be the student
24:35who will receive feedback,
24:37and the third will be the observer.
24:42Alright, can we share the video?
24:49So don't go just yet because we're
24:51gonna sorry I opened one prematurely.
24:53Watch the video first, please. Thanks,
25:00everybody. Before we start the
25:02video though, does anybody have any
25:04questions about what we're doing here?
25:09All right. So we're just watching
25:11the video and thinking about what
25:13feedback we might give that student
25:15who you will see speaking in the video.
25:18Thank you. Thank you.
25:19Linda, I think you can start it now
25:24so we don't hear the volume.
25:26I'm not sure if I'm the only one.
25:33So Karen, would you mind?
25:35So we think that might be a place for
25:39us to start. So Karen, would you mind?
25:41So we think the cause of your
25:44symptoms is something called
25:46benign prostatic hypertrophy,
25:48and this occurs when the prostate enlarges.
25:50This can be due to a variety of factors,
25:52including your own endogenous testosterone.
25:55And what happens is that as it enlarges,
25:57it pinches the urethra and so you have
26:00a difficult time emptying your bladder
26:02and your urine stream is thinner.
26:04Other more rare causes of your symptoms that
26:07would be much less likely include prostate
26:10cancer and also a neurologic condition.
26:12But we don't think that's
26:14what's going on here.
26:16So let me tell you about
26:17what we can do about it.
26:18There is a very common surgery that's done.
26:21It's called a transurethral resection.
26:23And what the surgeon would do would be
26:25to go up through the penis and remove
26:27part of the prostate and that would
26:29relieve the pressure and allow you to,
26:32this is a very safe surgery,
26:33nothing to worry about,
26:34but we don't think you need it
26:36right now because you haven't tried
26:38medication yet and medications really
26:39the first line of treatment for this.
26:41So what we wanted to do is start you
26:43on something called an alpha block,
26:45and what that's going to do is
26:47relax the muscles of your urethra
26:48and allow you to urinate.
26:49There's one major side effect that
26:51you want to be looking out for,
26:53and that's orthostatic hype of tension.
26:55So you'll need to give us a
26:56call if you feel dizzy.
26:57Otherwise it can cause dry mouth
26:59and very rarely allergies.
27:01But we think you're going to do fine
27:03on this medication in the future.
27:05There's another medication called the
27:065A reductase inhibitor and that would
27:08actually shrink the size of your prostate,
27:10but it has some negative side
27:12effects like a loss of libido or
27:14the inability to hold an erection.
27:15So we're going to hold off on this.
27:18And then of course,
27:18there's always the option of doing nothing,
27:20but it sounds like you're
27:21too uncomfortable for that.
27:22So we would recommend it.
27:24So,
27:24and finally,
27:25the last thing we want to do before
27:27you go today is get a urinalysis
27:28just to make sure you don't
27:30have urinary tract infection.
27:31Could my husband really have prostate cancer?
27:35And we had a dear friend who
27:37recently died of it and he had the
27:39same symptoms that my husband has.
27:41I'm just worried sick about this.
27:43Do you think we ought to see a specialist?
27:46So we're gonna do a blood test for
27:49prostate cancer called the PSA test.
27:51I know we've given you a lot
27:52of information today,
27:53and so I think it's best to just
27:56take things one step at a time.
27:57First, the blood test for prostate cancer,
28:00Also the urinalysis.
28:02And we'll give you a prescription
28:04for telmisart.
28:05OK.
28:06Yes,
28:06sounds fine,
28:09Karen. Thank you very much for that
28:11explanation. I think we've given
28:12you a lot of information today
28:15and I'd like to begin by talking
28:16about a few other things.
28:25Alright. Thank you, Linda.
28:27So we'll go into our breakout
28:29rooms again in groups of three.
28:32Pamela, do you have a question?
28:34I do. When we break out the student
28:36is going to, I'm a little confused
28:40about. It's very clear the attending
28:41can give feedback in the observer,
28:43but the role of the student,
28:45is it from the video or from
28:48I'm confused about the student.
28:50Where's the student getting their info?
28:52Right. The student is the student
28:54in the video, so the feedback
28:57will sort of role role plays.
29:00The student and receive feedback from the
29:03attending will be the giver of feedback.
29:07You can use your handout for adapt to help
29:09you go through the different steps of adapt.
29:12We have a second handout that
29:15has listed the questions that
29:17are in each step of the ADAPT.
29:20So if you want to refer to that,
29:22that might be helpful.
29:23And then you have about 15 minutes
29:25in your breakout rooms.
29:27So that initial feedback conversation
29:29might last for 7-8 minutes and then
29:31the observer giving feedback on the
29:33feedback might be the rest of the time.
29:35If you have extra time left over,
29:38certainly the student who was the
29:40observer can also practice giving
29:42feedback and we'll try to pop into your
29:45your breakout rooms as well so that we
29:48can help you along with the process.
29:50And
29:50again yeah sorry I was just gonna
29:53say often when you're busy like and
29:55the breakout session part comes,
29:57you leave the meeting.
29:58Please don't take a chance to take a
30:01take a moment to do this together.
30:03It's 0 stakes environment in which you
30:06can practice a skill that is very useful.
30:08So we hope you stick around.
30:10Yeah. Thank you. Thank you,
30:11Susan, for that reminder.
30:13And one more reminder that the
30:15goal that you came up with the
30:18student to have that feedback,
30:20conversation on is shared decision making.
30:23So that that's the goal
30:25that that was decided upon
30:27exactly. And try not to get into the
30:29content because as an internist there
30:31are so many things that are not right
30:32in terms of what's being said that's
30:34not really don't focus on the content,
30:37more on shared decision making in
30:39the process of giving feedback.
30:42All right. So Reagan or Linda,
30:45if you could open the breakout rooms,
30:47they are open and everybody can
30:49feel free to go in their rooms.
30:56Welcome back, everybody.
30:58So First off, I want to apologize.
31:00I know there were some of you who
31:03didn't get a chance to watch the
31:05video and went into breakout rooms
31:07before we were able to do so.
31:10But nonetheless,
31:11I appreciate that you all were
31:14still having conversations in
31:15your breakout rooms about some
31:17of the the aspects of feedback
31:19that we brought up earlier.
31:23No, actually can we just have no slides? And
31:28sure, yes, I will see each
31:31other better. I like that.
31:34Yeah. So just wanted to open this
31:36up for some initial reflections.
31:42What was easy?
31:43Was there any part that might be
31:47difficult when you were having this
31:49conversation and using the ADAPT model?
31:51And please feel free to unmute yourselves
31:54and and speak or put in chat as well,
31:58whatever you prefer. Hi,
32:00this is Khushboo.
32:01I'm internal Medicine from Southport.
32:03We were doing our small group discussion
32:05and we breaked out before we could
32:08have more detailed discussion.
32:09But the person who was the
32:11attending was Charlotte.
32:11She was excellent.
32:12She did the ADAPT model.
32:14But my question is when we are
32:17about to discuss and give feedback,
32:19this particular attending chose
32:21to ask the student.
32:23May I give you some feedback?
32:25How do other attendings
32:26approach giving feedback?
32:27Do they get permission from the student?
32:29Is that a good idea?
32:31Is there any other way of
32:33getting into it smoothly?
32:39I usually just say is this a
32:41good time to give feedback
32:42rather than do you you want to feedback?
32:45Is this a good time?
32:46So I I always say yes,
32:49we're going to give you feedback
32:51is but you know are you,
32:52are you willing to accept it?
32:55And I would say I heard this come up
32:57in the group that I joined laying
33:00the groundwork for that in terms
33:02of saying we're going to be doing
33:04feedback a lot during this rotation.
33:06It's goes both ways.
33:07Let's make sure that we,
33:09you know if you have things
33:10that that you noticed,
33:11please tell me and I will tell
33:12you at the time that I see it.
33:14So don't be surprised.
33:15So kind of laying that
33:17groundwork can be helpful.
33:18And then also just having that
33:19awareness that there are times
33:20where it's even though it's timely,
33:22it's not a good time to give feedback.
33:23So if someone is looking like
33:25they haven't slept for 25 hours,
33:28they're probably not going to be
33:29able to take that feedback, right?
33:31Thank you.
33:33Yeah, definitely. I mean,
33:34having that situational awareness
33:36is important, but at the same time,
33:38it's also important to normalize
33:40the process of feedback.
33:41So rather than asking permission for whether
33:44we can have a feedback conversation,
33:47I I like Scott. What you mentioned
33:49in terms of sort of asking,
33:51is this a good time for feedback?
33:52But the more you normalize it,
33:54the easier it will get and it
33:56will lay the foundation for your
33:59ongoing longitudinal feedback
34:00conversations because that's that's
34:02what the goal is going to be.
34:04One of the things that Doctor Kron
34:06brought up in the breakout room was
34:08how do you address the power dynamics
34:11when it comes to having a feedback
34:13conversation and how does that creep
34:16in to when we're having that dialogue?
34:19Would love to hear any reflections
34:21or thoughts from the group.
34:26Erin did a really great job in our
34:28group because she used the word we,
34:30which implied A collaboration,
34:32especially toward the end of our discussion.
34:35And I think that's a very effective
34:37word to use the word we in our
34:39feedback with our students.
34:42Yeah, that's excellent.
34:43Another thing that I've found to be
34:46helpful when you're trying to minimize
34:49the power dynamics is also being open
34:52to receiving feedback as an attending
34:56and also discussing it right at.
34:59So for example in GI clinic at the beginning,
35:03I'll say you know that's great.
35:05I'm glad you're joining me in clinic today.
35:07At the end of clinic we're
35:09going to do some feedback.
35:11I'm happy to receive any feedback
35:12that you might have for me as well.
35:15And please tell me if there are
35:17things you want me to continue to do,
35:19things you want me to do better,
35:21and if there are things that
35:23are working for you or things
35:24that are not working for you.
35:26So it allows the trainee to realize that yes,
35:29I'm gonna give them feedback,
35:30but I'm also open to receiving that.
35:35I think that's this is all quite good.
35:39I like the idea. Is it James of using
35:44we statements and being inclusive?
35:48Sometimes I've gone a step further and
35:51say you know we're all working together
35:54as a team and we're most effective as a
35:57team if we're honest with one another.
35:59So feel free to talk up and share your
36:03feedback with me and that way will
36:06be a success together or something
36:08along those lines that that may
36:11not have been the absolute best,
36:13but you see what I mean?
36:19That's a great learning climate
36:21where people feel comfortable
36:23exactly. So it's that feedback stool
36:25where one of the legs of that feedback
36:28stool is the learning climate.
36:30And the more time you spend in
36:33building that climate that the harder
36:35and easier it will be for you to
36:37sit on that that feedback stool,
36:39the other legs being goal setting
36:42as well as having that dialogue.
36:46I think it's rare that we interact
36:48with students or with colleagues
36:50or that we don't learn something.
36:52And so I think it telling
36:54the student what I learned,
36:57like if there was something they
36:58said this would be helpful for me.
37:00And I I think it's great to be able to say
37:02to them you know what that's a great idea.
37:05I think I'm going to incorporate
37:06that in my practice too.
37:08And so I feel like that's it's is transparent
37:12and it builds confidence and it's good.
37:15It's something that I can use telling
37:17them that there's something I can use
37:19as opposed to giving a laundry list
37:20of these are all the opportunities
37:22for you to improve yourself because
37:24you are in the if they're learning.
37:27So they're obviously going to be
37:28trying to improve themselves.
37:30But yeah,
37:32that's that was sort of something
37:34that came up in our group is sort of
37:36if the student reveals something,
37:38say, you know what,
37:39that's that's pretty sharp.
37:40I'm gonna, I'm gonna use it.
37:41I'm gonna adopt it if it's,
37:43you know, if
37:46you don't mind or even a
37:47phrase that you wanna steal.
37:49No, that's perfect.
37:51Thank you. All right.
37:53So I think we'll move on.
37:57Susan, did you wanna pull
37:59that presentation back up?
38:35I'm so good at Zoom.
38:36Takes me 10 times longer than it should.
38:39So. So in summary, we're hoping
38:43that you will consider using
38:45the ADAPT model for a feedback
38:47conversation that incorporates
38:49the learner's self-assessment and
38:51readiness and addresses modifiable
38:54specific behaviors and helps them
38:57develop strategies for improvement.
38:58So those those are the really the
39:01basic premises as opposed to just
39:03out output of of things that you
39:06think that they could do better.
39:08So what we would love to do is
39:11hear first of all if you could
39:14do the evaluation feedback.
39:16This is will take a minute for
39:18you to do that and then we will
39:21open it up to more questions.
39:33Keep it specific, modifiable.
40:10All right, so while you finish doing that,
40:12we would love to hear any questions
40:15or comments that you have or things
40:17that you will be taking away from
40:18this session to use in your practice.
40:25A quick question,
40:27how how would you recommend
40:30dealing with apathy?
40:34So you're you're trying to give
40:36feedback, you're trying but
40:38you you're kind of stuck or
40:39or hitting a like a brick wall or or.
40:42And I know a lot of it has to do with
40:45what Doctor Patak was talking about
40:47reading the environment and kind of you know,
40:50is this person open to the feedback.
40:51But when you do encounter
40:53that that situation,
40:55what what would your recommendations be?
40:59How do you? Great question.
41:01Yes, great question.
41:02So there are definitely challenging
41:04feedback situations and we can
41:05talk about that for just a moment.
41:06I will share my screen and
41:12OK, so in the interest of time we
41:15didn't really get into this and
41:16hopefully we'll have a session
41:18delving into this more in the spring.
41:20But for either learners who lack insight or
41:23appear defensive or this professionalism,
41:25or learners that don't integrate feedback,
41:27it can be more challenging.
41:29But some of the basic steps are to
41:31really approach it with appreciative
41:32inquiry like try to understand it
41:34may seem like they're apathetic it
41:36there might be something else going
41:38on and really try to build that
41:42relationship and and and try to
41:45find out their perspective on it and
41:49then be really behaviorally based.
41:51So, so you know when you are on your
41:55phone during rounds the perception
41:57can be that you are not interested or
42:01you know when you when you look away
42:05when a patient is talking to you,
42:07the perception can be that you're distracted.
42:10So really trying to go behaviorally
42:14and then try to emphasize the impact
42:17that that has on other people,
42:20so especially their patients and try to.
42:23And sometimes it can be helpful in
42:26those situations to get trusted
42:27mentors to be part of it.
42:29Maybe they're not hearing it from
42:31you or they're not able to take that
42:33feedback from you at that point.
42:35And it might require multiple conversations.
42:39So those are some of the things
42:41that that can be helpful.
42:43Any other ideas from others say
42:46actually I think that the apathy.
42:49I feel like this is what I used to
42:51do before I was when I was like
42:52more performance oriented until I
42:55switched to more learning oriented.
42:57As a human, I just feel like apathy
43:00is a defense mechanism to try to
43:02take the feedback without reacting to
43:03it. And I feel like it would have been
43:06helpful for me like a while ago if
43:10the person giving me feedback had circled
43:12back like a couple days later.
43:13Because often people who get that feedback
43:15that way need a couple days to like,
43:17process it and think about it.
43:19And I think circling back is often
43:21very helpful to say like hey,
43:22I know we talked about some
43:24feedback the other day.
43:25You know you've had a little
43:26time to think about it.
43:27Anything I could help
43:28you with to reach your goals
43:30or to make that feedback,
43:32you know, something useful for
43:33you as you grow in your career,
43:35something like that,
43:36that's more like team based and
43:38supportive Because I I think it
43:39really is just helping someone
43:41switch from a performance oriented
43:43to a learning oriented mentality.
43:45And I think that that really helps
43:46shepherd that a little bit forward.
43:49But that's just my experience.
43:51Yeah, that's fantastic. Thank you.
43:55And kind of as a way of
43:56operationalizing that,
43:57sometimes I find it helpful to
43:59like have an index card for the
44:01learner when I'm going on on a
44:03service where we first have that
44:04conversation of what are your goals.
44:06And I write down their goals and I try
44:07to get them to be specific so that
44:09we've made kind of a pledge to each
44:11other that we're working on that.
44:12And then when we have feedback conversations
44:15or or if I'm observing something,
44:16just making columns of like reinforcing,
44:18correcting corrective feedback
44:19so I can remember that even if I
44:22can't give the feedback right then.
44:24So if they are leaving overnight and you
44:26know, there's just no time to do it,
44:28I'll say, hey,
44:29can we talk about a few things
44:31tomorrow about about this encounter
44:34and then go through it then?
44:36And that allows me,
44:38even though I'm absentminded,
44:39to try to remember what it is that
44:42we talked about so we can revisit
44:43it in like mid, mid,
44:44rotation feedback and end of
44:46rotation feedback. How's that going?
44:48What can we be doing better
44:49to achieve your goals?
44:50What other goals do you have?
44:56Susan and Uma.
44:57It's after one though it seems
44:59like people are happy to chat,
45:02so I know that I'm able to stay on.
45:04But those of you who need to hop off, great.
45:07If you wanna stay a few more minutes,
45:09I'm able to stay.
45:10I don't know if you,
45:11Uma and Susan could stay
45:13for a couple more minutes.
45:15Absolutely. And I really appreciate
45:17everyone's attention and
45:18engagement today. Thank you. Yeah.
45:20Thank you very much, everyone.
45:24One thing that so I popped into
45:27the room that James was in as the
45:31student and one thing that I really
45:34liked about James role as the student
45:36is he really paid attention to the left
45:39hand side of the ADAPT model and you
45:41know ask some really pertinent questions
45:44so took an active role as a learner.
45:46So I thought James you demonstrated you
45:49know how that should go on the side
45:51of the student if they're not exactly
45:54getting you know the feedback that they need.
45:57I mean, Aaron was doing a great
45:59job in giving what he needed,
46:01but he was also very specific
46:03about some questions.
46:04So I thought that was great.
46:11Any other takeaways, things that
46:12you might want to incorporate?
46:18I think this is all very valuable
46:20and I will definitely carry
46:21these lessons with me as I see
46:23as I see students and patients.
46:24Thank you very much.
46:26Thank you very much.
46:29Please don't hesitate to reach out to us,
46:31e-mail us if any questions come up
46:33because this was just an initial sort of
46:36snippet into the conversation of feedback,
46:38but there's so much more beyond this.
46:44Gonna sign off. Thanks again.
46:45Thank you. Nice seeing
46:46you guys. Bye, bye. Bye.