1/5 YES!: Improving Written Feedback

Transcript

• 00:00But thank you for joining us and the
• 00:03tag team that we have is that I'll
• 00:06say a few words about the series.
• 00:08Yes, the all medical educator series that
• 00:12I've had the great fun and privilege of,
• 00:14of putting together with with Dana.
• 00:17And we have put together roughly a
• 00:19dozen or so talks over the course
• 00:22of the year where we're hoping to
• 00:25give very practical materials to
• 00:28educators ranging from how to well,
• 00:30how to do everything that as clinical
• 00:33physician educators we need to do.
• 00:36And we will be talking about feedback
• 00:37today and we certainly welcome your
• 00:39feedback about the series as a
• 00:41whole in addition to the feedback
• 00:43to the session itself.
• 00:45So with that,
• 00:46I will pass it on to my compadre,
• 00:50Dana to introduce our speakers.
• 00:51Dana,
• 00:54thank you, Andreas.
• 00:56Happy Friday everybody.
• 00:58Thanks for joining.
• 01:00Dana Dunn, Infectious Disease Co
• 01:02Director of this series with Andreas.
• 01:05And I'm happy to welcome two of my
• 01:08colleagues who have given this talk.
• 01:09When we did this in the Department of
• 01:12Medicine only for the last few years and
• 01:14it's been really well received as helping us.
• 01:18For so many of us that need to
• 01:21write evaluations on learners,
• 01:22regardless of the level
• 01:24that they're they're in,
• 01:25they're going to introduce
• 01:26you to a helpful framework.
• 01:28So I'm excited to introduce
• 01:30Matt Grant to you both,
• 01:31to all of you today.
• 01:33He's an infectious disease colleague
• 01:34of mine who's an Associate program
• 01:36Director for the Internal medicine
• 01:38Residency program and Laura Morrison,
• 01:40who is in the section of
• 01:42Geriatrics who directs hospital
• 01:44and palliative care education,
• 01:46as well as is the director of the Hospice
• 01:49and Palliative Care Medicine Fellowship.
• 01:51So they're going to chat with
• 01:53us for a while and at the end,
• 01:55we're going to remind you
• 01:56about some upcoming sessions.
• 01:57So over to you,
• 01:59Matt and Laura.
• 02:01Thanks for that introduction, Dana.
• 02:03It's really great to see everybody's faces.
• 02:06Happy New Year.
• 02:07I'm in day three of COVID Isolation
• 02:10after a trip to New York City.
• 02:12Essentially, I'll timed.
• 02:13So you're relieving my loneliness
• 02:15and you're boosting my mood,
• 02:17so I thank you for that.
• 02:19Our CME code for today,
• 02:21as is referenced in the chat, is 38938.
• 02:27All right, So we're really
• 02:28excited to be talking to you
• 02:29today about written feedback.
• 02:31We have three big goals set
• 02:33up for your objectives.
• 02:34One is to talk about best
• 02:37practices for delivering and
• 02:38actually writing written feedback.
• 02:41We want to talk about some barriers
• 02:42that are in place that are real and
• 02:44they do hinder us and we actually
• 02:47want to move through the theoretical
• 02:49and lecture based piece of the
• 02:52talk rather swiftly because we
• 02:53actually want to do some practical
• 02:55writing with you guys today.
• 02:56So we want to have you put keys to
• 03:00key fingers to keyboard and we're
• 03:03going to be using the chat to
• 03:06actually write down some written
• 03:07feedback based on some clinical
• 03:09scenarios or student learner
• 03:11scenarios and we're going to give you
• 03:13some kind and supportive feedback.
• 03:17All right. So three parts of the talk today.
• 03:19We're going to be giving a little
• 03:21bit of background and then we're
• 03:23going to be introducing a new
• 03:24model for you to practice today.
• 03:26And if you like it,
• 03:27we hope that you will use it a little bit
• 03:29or a lot moving forward into the future.
• 03:31And then we're going to spend
• 03:32the about half the session,
• 03:33we hope actually doing some writing
• 03:35because it is a written feedback talk.
• 03:41All right, so as I mentioned before,
• 03:44there are legitimate barriers
• 03:46to written feedback.
• 03:48Good read, good written feedback
• 03:49does not occur in a vacuum.
• 03:51It is part of a admittedly time
• 03:54intensive process which typically
• 03:56begins with when you meet a learner
• 03:59doing goal and expectation setting
• 04:01and then putting yourself in the same
• 04:04space as the learner so you can observe
• 04:06their skill set and take note of it.
• 04:08And then if the if the observation
• 04:11period is long enough,
• 04:12doing some mid rotational verbal feedback.
• 04:15And then we always like to a
• 04:17tenant of written feedback is that
• 04:19it should be coupled to kind of
• 04:22synchronous written feedback.
• 04:24So the written feedback and
• 04:25the verbal feedback that the
• 04:27learner receives should match,
• 04:29should dovetail very, very well,
• 04:31be very, very close to each other.
• 04:33Another obvious barrier is a
• 04:35limited observation window.
• 04:37For example with the throughput
• 04:38issues involving the emergency
• 04:40room and the respiratory viruses
• 04:42going on when when I attend,
• 04:48when I attend on the Donaldson
• 04:50firm in East Pavilion.
• 04:51We don't get a lot of fresh admissions
• 04:53because a lot of patients need to
• 04:54get admitted by hospitalists while
• 04:56they sit in the ER for 24 hours.
• 04:57Though I don't get to see unfortunately
• 04:59a lot of of my medical students you know
• 05:02sub is and interns do fresh work up.
• 05:05So you know we we can only see
• 05:06what we can see and we can try
• 05:08to be there as much as possible
• 05:10but we do have limitations there.
• 05:12Faculty skills is a barrier.
• 05:15I applaud all of you for being here
• 05:17today being proactive about trying to
• 05:19develop your skills and written feedback.
• 05:21It's been a process for myself,
• 05:23and I'm sure it has for Laura
• 05:24and Dana and all these people who
• 05:27are in a teaching position.
• 05:28And sadly,
• 05:29fear is a really important
• 05:31barrier to written feedback.
• 05:32There's a lot of misinformation out
• 05:34there about what the implications of
• 05:37written feedback can be for a learner.
• 05:40Some people mistakenly think that
• 05:42what you write in Med Hub or in
• 05:44other scenarios will follow the
• 05:46learner in some sort of negative way.
• 05:48People are scared about their
• 05:51own faculty positions,
• 05:52are scared sometimes about their own
• 05:54promotion and how if giving constructive
• 05:55feedback to the learner may kind of
• 05:57bounce back and hurt them when it
• 05:59comes to the time of their own promotion.
• 06:02And lastly,
• 06:03you know,
• 06:04if you reach out to somebody's
• 06:07mentor and and tell them you think
• 06:09someone's really skill deficient,
• 06:11people feel that they could be at risk
• 06:12for getting pulled into a real time sink.
• 06:16So I've been interested in this written
• 06:19feedback issue for several years.
• 06:20I had the pleasure of in 2019 doing
• 06:23a Med Ed fellowship working with
• 06:25Janet Hafler and John Encandela,
• 06:27and I chose an audit of the internal
• 06:31medicine residency's attending to
• 06:34resident written Med hub evaluations.
• 06:38I did a qualitative and quantitative
• 06:41analysis and I coded all the free
• 06:44form written feedback that went from
• 06:47attendings to both interns and residents.
• 06:50And the most important take away point
• 06:52of that is that we were giving at
• 06:54that time and we still are giving an
• 06:57incredibly small amount of actionable,
• 06:59constructive feedback to our learner.
• 07:01So on average,
• 07:01you'd have to work with two
• 07:03attendings for enough time to get
• 07:04them both to fill out an evaluation,
• 07:06which was not inevitable to get
• 07:08one piece of behavioral change
• 07:10that was recommended to you.
• 07:11So that was a little sad to me
• 07:14and that drive my interest in
• 07:16this realm for the last five,
• 07:18and it will continue for many more years.
• 07:21We don't have time to do a deep dive on this,
• 07:23but both gender bias and racial bias are
• 07:27prevalent and well described in this realm.
• 07:31This particular study that I'm referencing
• 07:33here involved emergency medicine.
• 07:34Residents and residents identifying as
• 07:38female less consistently got feedback
• 07:41about how to improve their skills,
• 07:43and they also got descriptors that
• 07:45more prevalently described their
• 07:47personality rather than things that
• 07:48were associated with their behaviors
• 07:50and their team leadership skills
• 07:52and kind of the things that we
• 07:54would think would lend people to be
• 07:55selected for leadership positions.
• 08:00Likewise not this is in the
• 08:04undergraduate medical domain.
• 08:05This is about clerkship students.
• 08:09So this is like a a map of what
• 08:12attributes were related to people
• 08:14based on the grade they got on the
• 08:16rotation and whether they were under
• 08:18represented or not in medicine.
• 08:20And you can see here highlighted
• 08:22in the lower right quadrant that
• 08:25under represented in medicine.
• 08:27Clerkship students again received
• 08:29more personal attribute descriptors
• 08:32and they were less likely
• 08:34to receive competence based.
• 08:36And you can see there were often, you know,
• 08:39appreciated for their bilinguality,
• 08:42but that we're missing a lot of
• 08:46these specific leadership traits.
• 08:51So when we think about written feedback,
• 08:53we don't think about it
• 08:55just as an evaluation.
• 08:56There's really three parts or like
• 08:58a tripod that good written feedback
• 09:01sits on and that is appreciation.
• 09:03So appreciation is really important.
• 09:05It reinforces the effective and the
• 09:08effective things that the learner's doing,
• 09:12the strong things.
• 09:13And it helps build that learning
• 09:15climate so that you can safely deliver
• 09:18constructive feedback and that that
• 09:20constructive feedback can be taken in
• 09:22a in a kind and respectful and that
• 09:25the the learner wants to implement
• 09:27change and isn't taken aback by what
• 09:29you're telling them to do better.
• 09:30So that's the coaching leg of the
• 09:32tripod that I was just talking about.
• 09:38Everybody wants to improve.
• 09:41Ideally, they want to do so in
• 09:43a nurturing environment where
• 09:44they're supported and they feel
• 09:46valued and that the that their
• 09:48preceptor or mentor in them cares
• 09:51about them both as a person and as
• 09:53a developing physician or learner.
• 09:58And so all these things are important.
• 09:59And lastly, the evaluative part is
• 10:02I'm going to get into why evaluation
• 10:04is so important and that's not
• 10:06the part that people who are not
• 10:09in leadership positions within
• 10:11educational leadership tend to focus on.
• 10:13But it is really important.
• 10:17So what makes written feedback so important?
• 10:19Well, it does tails as I said or
• 10:22reinforces the verbal feedback.
• 10:23So when you meet with someone at the
• 10:26end of a rotation, for instance,
• 10:27and then you tell them one thing,
• 10:29and then ideally you know a few days or
• 10:32a week later they read the same thing,
• 10:34they're more likely to kind of
• 10:37internalize that feedback, act on it,
• 10:39cannot keep it in their mental
• 10:42register as they move forward.
• 10:44It's also a really important
• 10:46source for a variety of, you know,
• 10:50committees and things such
• 10:52as letters of recommendation,
• 10:53Mspes or Dean's letters.
• 10:56That so especially that positive
• 10:58reinforcing feedback that you're
• 10:59giving in the written feedback
• 11:01realm is helping our learners
• 11:04achieve their professional goals and
• 11:11really helping us create milestones
• 11:13and observe a trajectory of somebody
• 11:15as they grow from someone who
• 11:18requires a lot of assistance in the
• 11:20patient care realm to eventually
• 11:22ideally becoming fully independent.
• 11:31So in general this applies to both written
• 11:33and verbal feedback. But what does good
• 11:35feedback look like? Well,
• 11:38it should be sorry.
• 11:41It should be well intended
• 11:42and based on shared goals.
• 11:44It should be observed as a direct behavior.
• 11:49We like to get away from describing
• 11:52someone's personality in an evaluation and
• 11:55really describing their actions and their,
• 11:57you know, if we're going to say how you know,
• 12:01kind they are or how much they
• 12:02advocate for their patients or
• 12:04the rapport they're building.
• 12:05I think specific behaviors or anecdotes
• 12:07are always so much more powerful to me.
• 12:10When I'm reading, let's say,
• 12:12a letter of recommendation in my
• 12:14position as like selecting candidates
• 12:16for residency or fellowship,
• 12:18I feel like that's so much more meaningful.
• 12:20Good feedback should be directly observed,
• 12:23should be a very specific thing,
• 12:26should be as timely as possible,
• 12:28and it should be manageable.
• 12:29So when I have somebody on the Donaldson
• 12:32firm doing HIV medicine with me,
• 12:34you know it's not reasonable
• 12:35for me to give the feedback.
• 12:36You know,
• 12:37like you should learn and be
• 12:39comfortable prescribing antiretrovirals.
• 12:41That is a really complicated
• 12:43goal and someone needs a really
• 12:45well defined path that needs to
• 12:46be broken down into steps.
• 12:48So you can't just,
• 12:49you can't just throw something that
• 12:52is that complex out and ask someone
• 12:55to perform to gain progress or gain
• 12:57skills that are such a multi step process.
• 13:04Feedback comes in a couple different forms.
• 13:06There's both formative which is kind
• 13:08of in the process of learning, whereas
• 13:10summative feedback is more evaluative.
• 13:13Formative feedback can come in the form of,
• 13:15you know, texts, emails either to
• 13:19the learner or to their mentors
• 13:21to let them know about, you know,
• 13:24both reinforcing and constructive.
• 13:26Sometimes we want to hear about
• 13:27and we do hear about really amazing
• 13:29things our residents and interns
• 13:31and students do on the floors.
• 13:33And at other times we hear that
• 13:36someone is kind of not on trajectory,
• 13:39not on target with their peers and
• 13:40they're going to need a little
• 13:41bit of help in catching up.
• 13:43It's really important that
• 13:44we know both things.
• 13:48Many of you who are here today in the
• 13:50audience may work with students or
• 13:52residents in workshops or in like a
• 13:55standardized patient encounters or Epas.
• 13:57And those are another example
• 13:59of feedback that's important.
• 14:00Whereas summative or as I said kind of
• 14:03like the at the end where you're kind
• 14:05of making an evaluative like is this
• 14:08person ready to graduate, you know,
• 14:09how is this person ranked as a candidate.
• 14:11Moving on, graduating from medical school,
• 14:14you know these are no longer
• 14:16serving a coaching role,
• 14:18but this kind of written feedback is
• 14:20serving more of a an evaluative role.
• 14:26So a couple pros about written feedback.
• 14:28Both the learner and the mentor
• 14:30can refer back to it over time.
• 14:32Whereas you know with verbal feedback,
• 14:33you hear what you hear and you know
• 14:36human memory is not infallible.
• 14:37We can kind of twist things
• 14:39in our minds over time,
• 14:40but the written word stays the same.
• 14:42It can be helpful for documentation to make
• 14:45sure if somebody needs some help catching up.
• 14:49As I mentioned that that's their kind
• 14:52of begins a process of identifying
• 14:55what's going on with the learner
• 14:57and taking steps to come up with
• 14:59a plan to help them catch up.
• 15:01Cons of RIN feedback is that if it's not
• 15:03done without concomitant verbal feedback,
• 15:05you're missing an important opportunity for
• 15:08the learner to self assess about their skill,
• 15:11to watch them physically react
• 15:13to the feedback you're getting,
• 15:14and to engage in like an open
• 15:17dialogue about it.
• 15:18And if the written feedback doesn't contain
• 15:20or imply a specific plan for improvement,
• 15:23it kind of tends to just make the
• 15:25person feel bad about their skill set.
• 15:28And if they don't have a way that's obvious
• 15:30or told to them about how to get better,
• 15:33then it just seems,
• 15:35you know, derogatory.
• 15:37And it's can be frustrating to not know
• 15:40what where to take negative feedback
• 15:42that doesn't have a plan of where to go.
• 15:47All right.
• 15:47So at this point,
• 15:47I'm going to turn it over to Laura Morrison,
• 15:50and she's going to tell you about a new
• 15:52framework for doing written feedback
• 15:53that we hope you're going to practice today.
• 15:56Thanks, Matt. I want to take this
• 15:59opportunity to just kind of end
• 16:01our stage setting by giving us a
• 16:03longitudinal look at all a lot of
• 16:06the concepts that Matt just laid out.
• 16:08So just realizing that whether we're
• 16:11interacting with a learner in a course
• 16:14or a workshop or a clinical rotation,
• 16:17there really is a beginning,
• 16:18a middle and an end.
• 16:20And each of those have a a possibility
• 16:23of an important contribution to feedback.
• 16:26Again, referring to the importance
• 16:28of setting goals and expectations,
• 16:31making them smart,
• 16:32kind of referring to that specificity
• 16:34and all the other important
• 16:37elements of goal setting.
• 16:38And remembering that Dana Dunn gave
• 16:41us a talk on that last month in
• 16:44this series that you can refer to.
• 16:46But the beginning is about that growth
• 16:49mindset that Matt mentioned and really
• 16:52establishing the opportunity for bi
• 16:55directional feedback and those expectations.
• 16:57So in my setting,
• 16:59I typically ask the learner what
• 17:01their goals are and then I actually
• 17:03share what mine are and what I'm
• 17:05actually working on and what I'm
• 17:07going to ask them for feedback about
• 17:09ahead of time for my own learning,
• 17:14right.
• 17:14And then we have this the mid middle
• 17:17period which is helpful because
• 17:19it's it's actually invaluable,
• 17:21it's the it's the time that we can
• 17:24actually provide some earlier feedback
• 17:25and then see if the learner is able
• 17:29to incorporate that feedback before
• 17:31the end of the experience together.
• 17:34And then of course at the end we have
• 17:37the opportunity to really make sure
• 17:39that the verbal and the written align
• 17:42and give and give sort of that double
• 17:45message to move people forward next slide.
• 17:50Great.
• 17:50And so this is our,
• 17:52this is the tool that we're interested
• 17:54in presenting to you today.
• 17:55It's called the BOSS model.
• 17:58We're not aware that BOSS has a
• 18:03particularly hierarchical reference
• 18:05and we're just acknowledging that it
• 18:09it's a tool for you to think about and
• 18:12see if it if it's a model that works for you.
• 18:14There may be some elements that do,
• 18:17but it's something that we're gonna practice
• 18:19today to see if it it kind of sticks,
• 18:22but it kind of has this BOSS.
• 18:24You know,
• 18:24we might use the term Riz if we
• 18:27had the opportunity to because
• 18:29that's the word of 2023, right?
• 18:32But they gave us BOSS instead.
• 18:34So BOSS stands for brief observation,
• 18:39significant and suggestions,
• 18:40and we'll take a minute here
• 18:43to look at it a little closer.
• 18:46But the brief observation
• 18:47part shouldn't be a surprise.
• 18:49We've been talking about how important
• 18:53directly observing behavior is,
• 18:55and so this reminds us to just take
• 18:57advantage of all the opportunities we
• 19:00can to directly observe and then it.
• 19:02I love this part about the model is
• 19:05it really reminds us of how important
• 19:07it is to frame our observations
• 19:09specifically for the learner to be able
• 19:12to receive it as effectively as possible.
• 19:15So we want to use a non judgmental,
• 19:18neutral if possible framing,
• 19:19and we'll look at that on the the
• 19:23next slide when we get there.
• 19:25But significance is is what we link to next.
• 19:29So we go from the observation to then
• 19:32thinking about what the significance is.
• 19:34And this is important because how we see the
• 19:38significance may not be the way that comes
• 19:40across as being valuable to the learner.
• 19:43So we really need to think
• 19:45about from their perspective,
• 19:47how they're going to see that what
• 19:49we care about is significant to them.
• 19:52And then we want a link at the end.
• 19:54Most importantly,
• 19:55as Matt pointed out from his study,
• 19:58that we really do need to be specific with
• 20:01a few suggestions and we want to aim for.
• 20:04You know, ideally 2 to 3 suggestions
• 20:07in how learners can improve.
• 20:09We want those to be specific and relevant
• 20:12to something that they could accomplish.
• 20:15Next slide, Matt, thanks.
• 20:18So we can go ahead and advance.
• 20:22So thinking about that judgmental aspect
• 20:25and trying to be neutral on the left side,
• 20:29we're going to see some comments that
• 20:31Matt and I have seen on evaluations.
• 20:33You know,
• 20:34Doctor X spends too much time on
• 20:36the computer in the patient room.
• 20:38So that's something that one of us might say.
• 20:41But how can we frame that observation to
• 20:43be a little more productive for the learner?
• 20:46So go ahead, Matt, look here.
• 20:49So another example might be eye contact
• 20:52between the doctor and the patient
• 20:54was less than 10% in this encounter.
• 20:57So making it again more objective and
• 21:00starting to lead into the significance,
• 21:03right. Next example, we just have one more.
• 21:07This one's a little more positive.
• 21:09Doctor X is very knowledgeable,
• 21:11but that doesn't really tell Doctor
• 21:13X what they're doing well or what
• 21:15was actually seen, right?
• 21:16So go ahead, Matt.
• 21:19So Doctor X routinely performs literature
• 21:22searches to develop their knowledge base.
• 21:25That gives the learner a little more of
• 21:27a sense of exactly what they're doing.
• 21:29Well, Next slide.
• 21:32So moving on to significance
• 21:35the first S and again,
• 21:38realizing that our framing as evaluators
• 21:40might be different from the learner,
• 21:43we might say something like, well,
• 21:44they tell me they're reading on
• 21:46their patients, but I can't tell.
• 21:48And instead if we're going to
• 21:49frame that for the learner,
• 21:51we might say, you know,
• 21:53sharing your learning points from your
• 21:56reading increases your team contribution
• 21:58and lets you practice your teaching skills.
• 22:01So really setting it out in
• 22:03quite a different way around,
• 22:05you know, learning specifically.
• 22:09And then the other example,
• 22:11they come late to clinic
• 22:13disrupting patient flow.
• 22:14So we might spin that one as well
• 22:17to how time management is important,
• 22:20effective time management maximizes
• 22:22learning opportunities in clinic.
• 22:26Next slide. So taking a minute to
• 22:29think about how we make suggestions,
• 22:32I think you'll all recognize these
• 22:34as common comments we see for what
• 22:37people can do to improve, teach more,
• 22:39read more, you know that's kind of
• 22:41the most common one ever, right.
• 22:43Instead we just want to be more
• 22:47specific and learner centered.
• 22:48So you know, I'd like to see you
• 22:51bring primary literature to rounds
• 22:53that is pertinent to how we are
• 22:55making our medical decisions, right?
• 22:57Or I we can just be much more specific
• 23:00about what someone should read,
• 23:03you know, some indications for
• 23:05diagnostic test or something else.
• 23:08So all right, on to the next slide.
• 23:12So that's the BOSS model and
• 23:15when we're thinking about BOSS,
• 23:16you know what are the things
• 23:18we want to observe,
• 23:19what are the points that we really
• 23:21want to make feedback on for learners.
• 23:24And I think we just wanted to remind you
• 23:27that we do have resources that can guide
• 23:29us and how we want to anchor our feedback,
• 23:32whether that's written or verbal.
• 23:36And just to remember for those of
• 23:38us in graduate medical education
• 23:40that all the primary specialties
• 23:42now and sub specialties all have
• 23:44their own milestones as evidenced
• 23:46here by a few examples.
• 23:49But also on the undergraduate
• 23:52medical education side,
• 23:53Yale in particular has we now have
• 23:56our own educational program objectives
• 23:59along with developmental milestones
• 24:02that we can reference in order to
• 24:05be more specific in our feedback.
• 24:08So with that,
• 24:09we're going to move on to part
• 24:11three and really get down to
• 24:14thinking about practicing boss.
• 24:16And before the next slide,
• 24:17I just want to reiterate what Matt
• 24:19had said at the very beginning.
• 24:22Our goal here is to have you try on BOSS,
• 24:25see how it feels.
• 24:27We are going to be providing you with
• 24:30little snippets to of comments and then
• 24:34asking you to improve on them using BOSS.
• 24:38And we're going to have you put your
• 24:40comments as you're comfortable into the
• 24:42chat after you've worked for a few minutes.
• 24:45And we just want to acknowledge that again,
• 24:47we're meaningless to be a safe,
• 24:50brave,
• 24:50low stakes setting where people can,
• 24:55you know,
• 24:56put out their,
• 24:57what they're working on and then we
• 24:59can give a little bit of specific
• 25:01feedback to the boss model.
• 25:03So nothing's going to be perfect
• 25:06here and we're just going to
• 25:08move forward in that spirit.
• 25:10So let's look at
• 25:11Laura before you move on.
• 25:13There's a question in the in the chat
• 25:16that I don't know if you can see it,
• 25:17I can read it. Go ahead, Dana.
• 25:21So Julio writes effective time
• 25:24management versus somebody who's
• 25:25arriving late sounds different to him.
• 25:27He was saying if he was arriving
• 25:30reading that arriving late
• 25:32might speak of professionalism.
• 25:33But time management could be
• 25:38something as takes too long with patience,
• 25:40takes too long writing notes.
• 25:41How do we navigate the line between honest
• 25:44feedback and not minimizing language
• 25:46due to fear of how folks will? Yeah,
• 25:49yeah, that's terrific Leo.
• 25:50Thank you. Yeah, Julio,
• 25:52I think that's that's really a nice
• 25:55comment and actually when I was looking
• 25:57at that I was thinking that to some
• 26:00extent too it can mean different things.
• 26:03I think there are ways though to also
• 26:06make learner centered suggestions
• 26:09and and create significance.
• 26:11You know, as far as things like being
• 26:15respectful to the rest of the team.
• 26:18I I think at some level it's a
• 26:21matter of again being creative and
• 26:23thinking a little bit deeply in a
• 26:26different direction about what is
• 26:28how we want to help the learner
• 26:30understand that their actions
• 26:32have different ramifications.
• 26:34Matt, I don't know if you
• 26:35wanted to add something.
• 26:36Yeah. I also think in the real world,
• 26:38I mean, when you do verbal feedback,
• 26:41often times, you know,
• 26:42you can tell them what you're observing and
• 26:44then there can be a dialogue to figure out.
• 26:46You know, it's often times there's
• 26:48a differential diagnosis for
• 26:49problems in the learner, right?
• 26:51If someone's showing up late first
• 26:52thing in the morning, I mean,
• 26:53I think more commonly that speaks
• 26:55to a professionalism issue.
• 26:57But if they're showing up
• 26:58late to afternoon clinic,
• 26:59I mean it could be that they're you know
• 27:02something from the morning they're doing
• 27:04something that's spilling over too long,
• 27:06their inefficiencies there.
• 27:07So I do think that before you write
• 27:10something you know evaluative about
• 27:12somebody you want to have that
• 27:14discussion we talked about where
• 27:15you're saying I'm observing this,
• 27:17what do you think is going on?
• 27:18And then it gives them a chance to explain
• 27:20and self assess what they think the issue is.
• 27:23And I think work together.
• 27:24So I agree.
• 27:25I mean I think you can.
• 27:27And as we move into this exercise,
• 27:29we're going to actually encourage
• 27:31you to take these little props or
• 27:34stimuli in different directions and
• 27:35be creative with it because a lot
• 27:37of times there can be many different
• 27:39reasons why you're observing a behavior.
• 27:41That's a great point.
• 27:43Yeah, I would agree.
• 27:45I think in that situation,
• 27:47a verbal feedback opportunity
• 27:50would would be really helpful
• 27:53to explore more before
• 27:55providing that kind of framing.
• 27:59All right, Matt.
• 28:00So the first writing exercises,
• 28:02we're calling it Boss it
• 28:04just to sort of think about,
• 28:09you know, being kind of funny about it,
• 28:11tongue in cheek, but also thinking about
• 28:14maybe Bruce Springsteen or whoever, right.
• 28:19But we're giving you a prompt.
• 28:20So in this case,
• 28:21one we've seen a lot as well as
• 28:24documentation needs to be more thorough.
• 28:26And we're gonna ask you to be
• 28:29creative and create some details
• 28:31maybe from your own experience that
• 28:33might fit just to practice the model.
• 28:36And so here we have an example where we said,
• 28:39you know I observed multiple times that
• 28:42Doctor Zee obtained history of present
• 28:44illness details at the bedside that
• 28:46didn't make it into their chart notes
• 28:49and obviously that's the observation.
• 28:53These were important to include
• 28:55as they provided the rationale
• 28:57to focus our diagnostic work up.
• 29:00So that gets at the significance
• 29:02and as we discussed Doctor Z may
• 29:05benefit from taking written notes
• 29:07at the bedside for their HPI.
• 29:09So one suggestion with
• 29:11some specificity there.
• 29:13So again,
• 29:14this is just playing around a little bit
• 29:17trying to see how this works for us.
• 29:19So we're gonna go on to the next slide
• 29:22and put up a couple prompts for you all.
• 29:25We put up two here,
• 29:27and we're gonna ask you to each
• 29:29of you to pick one of them,
• 29:31whichever 1 resonates a little bit more.
• 29:33And take about 3 minutes or so to try
• 29:37to work with this and write a specific
• 29:41behavior that you might have observed.
• 29:44Try to bring in some element of
• 29:47significance to motivate the learner,
• 29:49and then come up with a plan.
• 29:52And again, just be creative.
• 29:58And obviously folks are going to
• 30:02be working at different speeds,
• 30:03so we encourage anyone who's comfortable
• 30:05to just drop their writing, exercise
• 30:07in right into the chat and hit submit.
• 30:10And that way as some other people are
• 30:12finishing up during the three minutes,
• 30:13we can start to give.
• 30:15Because one of our goals here today
• 30:17is like not only to have you right,
• 30:18but to also have us give you some
• 30:21feedback about how we can, you know,
• 30:24get you using the the boss model.
• 30:25So encourage people to, you know,
• 30:30hit submit and there's going
• 30:31to be no judgement here.
• 30:32This is all for personal growth
• 30:35and this is a judgement free zone.
• 31:00Just let us know if you have any
• 31:02questions along the way as well.
• 32:43Oh thank you Julio.
• 32:49You want to take that one, Matt? Sure.
• 32:52So Julio started out with I observed Dr.
• 32:54Z checking on their phone
• 32:56frequently during rounds to perfect
• 33:00non judgmental observation.
• 33:04This led to distraction and
• 33:06orders not being correctly placed.
• 33:09Doctor Z explained he's
• 33:11having family problems.
• 33:12I suggested them to be forthcoming
• 33:15about these situations so we can
• 33:17allocate and protect their time to take
• 33:19care of emergent home situations and
• 33:21while also protecting patient care.
• 33:23Yeah, so this is,
• 33:24this is a really common situation
• 33:26that when we see people start to
• 33:29kind of underperform from a baseline
• 33:31of a higher performance level,
• 33:33a lot of times it's acute life stressors
• 33:36that are causing the decompensation.
• 33:37This is a great usage of the boss model.
• 33:41Julio, again,
• 33:42I think that you know for this
• 33:46particular situation,
• 33:47you know we probably wouldn't
• 33:49in like a Med hub evaluation,
• 33:52you know create written feedback
• 33:54that's specifically talking
• 33:56about someone's family problems.
• 33:58But you definitely you did exactly
• 34:02what we were looking for and
• 34:04this is the exact formatting.
• 34:05So kudos and definitely always
• 34:08thinking first like burnout depression.
• 34:11A sick family member.
• 34:14I'm glad
• 34:14I called you. Give me a second.
• 34:17These are always the be asking about you.
• 34:22All right. I see Michael
• 34:26Green wrote wrote an example.
• 34:28Let's see. Julio wrote something.
• 34:31Yeah, Julio's writing.
• 34:33I was thinking verbal makes
• 34:34sense not to include in Meadow.
• 34:36Yeah, I think that that is a a great,
• 34:39you know, using this great verbal
• 34:41feedback. It's perfect. Yeah.
• 34:44And I think what you're highlighting
• 34:46is that these principles can overlap
• 34:48into our verbal feedback as well.
• 34:50You know, the desire to try to be not
• 34:55judgmental in the way that we're framing
• 34:57things and also that specificity for
• 35:01the suggestions and the significance.
• 35:03So awesome Michael Green route.
• 35:07Reviewing their notes and presentations.
• 35:09Important diagnosis were missing.
• 35:11This could lead to missed opportunities
• 35:14for further evaluation or treatment.
• 35:19Perhaps begin with illness script
• 35:22to expand diagnosis possibilities.
• 35:26So I like that reviewing their
• 35:29notes is is that observation.
• 35:34I suppose it could be helpful to,
• 35:37you know in a certain instance
• 35:40give an example of a specific thing
• 35:43that was discussed between them,
• 35:45maybe during the rotation I'm presuming,
• 35:50but the significance is great.
• 35:51This could lead to missed opportunities
• 35:54for further evaluation or treatment.
• 35:56And then like the suggestion of
• 35:59beginning with an illness script,
• 36:01we would just need to make sure the
• 36:04learner knows what that terminology
• 36:06is referring to specifically.
• 36:07Probably.
• 36:10Thanks, Michael, for putting that in there.
• 36:15Looks like we have one
• 36:17from Kirsten. Matt, Yeah,
• 36:19I can. I can go through Kirsten.
• 36:20So, Kirsten said, I observe student aid
• 36:22looking at their phone several times during
• 36:25psych consultations with new patients.
• 36:27Though the student was
• 36:28sometimes in the observer role,
• 36:29this still may signal to the patient
• 36:30a lack of attention or empathy
• 36:32on the part of the team,
• 36:33and may erode patient trust.
• 36:35And it can also cause this student to
• 36:37miss key information Going forward,
• 36:39it might help student aid to limit
• 36:42cell phone usage to before or after
• 36:45sorry limit usage to also usage to
• 36:47before and after visits in order to
• 36:50ensure full attention on the patient.
• 36:52If urgent personal issues are present,
• 36:53the student is encouraged to
• 36:56briefly excuse themselves.
• 36:57This is fantastic, Kirsten.
• 36:59So you're saying you observe
• 37:01them looking at the cell phone
• 37:03during new patient visits.
• 37:05The significance is this kind of
• 37:07erosion of trust and lack of empathy.
• 37:11And it's you know kind of giving a a
• 37:14place for both like you know appropriate
• 37:17cell phone usage before and after
• 37:19the visit and then if something is
• 37:22truly timely to excuse themselves
• 37:24and acknowledge that they're they
• 37:26have a true crisis on their hand.
• 37:28Dana did you have a comment.
• 37:30Well, I was just gonna
• 37:30make sure that people that I
• 37:32think most people do know,
• 37:33but some might be thinking with respect
• 37:36to summative evaluations and if some
• 37:39of these are on summative clerkship
• 37:41evaluations or medical evaluations for
• 37:44residents that's that's not going to.
• 37:48They might worry about how that
• 37:50looks to in the Dean's letter or
• 37:52odd letters of recommendation.
• 37:54But you know there are these separate
• 37:57spots in the Med student evaluations
• 37:59where you can put the corrective
• 38:01and the reinforcing feedback.
• 38:02So this is such an important thing to not
• 38:06lose in documentation for the students.
• 38:08But and there is a spot for this
• 38:09that won't go into the Dean's letter.
• 38:11So people do recognize that
• 38:14for the students in particular.
• 38:16Yeah, yeah, yeah. I'll say I mean I love,
• 38:20I understands example because it
• 38:23goes into that professionalism realm
• 38:25and you know frames it in terms
• 38:27of the effects that this might
• 38:29have on patients and losing trust.
• 38:31And I think it's important to see that
• 38:34it's possible to frame it that way.
• 38:37And in my own experience on the CCC,
• 38:42one of my colleagues attended
• 38:44this workshop last year,
• 38:45I think and has actually been using
• 38:48the BOSS model now and most of the
• 38:51written feedback and it's been
• 38:53interesting on the CCC side to see
• 38:55that coming through and really it's
• 38:58it's been really helpful, I would say.
• 39:01So
• 39:02I also want to mirror what Dana said.
• 39:05The same is true for
• 39:06graduate medical education.
• 39:07I mean when we are providing letters
• 39:10of recommendation for fellowship
• 39:12or when you know I know for a fact
• 39:14when Mark Siegel's writing his
• 39:16letters like they're consciously
• 39:18omitting the constructive feedback.
• 39:20They're not gonna they're you're
• 39:23consciously leaving that out with
• 39:25creating the the letter recommendation.
• 39:27So we we, we know enough that we're
• 39:29going to select the reinforcing
• 39:31positive feedback and that
• 39:33really the constructive feedback
• 39:34is for the learners growth.
• 39:36Everybody has strengths and weaknesses
• 39:38and if we're not giving our learners
• 39:41constructive feedback then we're not
• 39:43allowing them to become the best
• 39:44versions of themselves they can,
• 39:46they can become.
• 39:49I was just looking ahead.
• 39:51I wonder, it looks like people are
• 39:54really getting the hang of the the
• 39:58BOSS components and doing a really.
• 40:02Lovely job with that. I wonder, Matt,
• 40:04if maybe we might move on to the
• 40:06next exercise just to switch it up.
• 40:08What do you think?
• 40:10Yeah, I know that sounds.
• 40:10I mean, I'm just skimming Andre's
• 40:13and it looks, it looks really great.
• 40:16Yeah. He did a similar similarly. Nice job
• 40:21of really highlighting the significance.
• 40:27All right. So in this last
• 40:32written exercise for you,
• 40:34we're going to kind of give you a
• 40:35little bit of a narrative here and
• 40:36then you can take this in whatever
• 40:38direction you want to take this.
• 40:39There could be,
• 40:40there is a differential diagnosis
• 40:43for what has been observed here and
• 40:45whatever direction you want to take it in.
• 40:46That's fine.
• 40:47So you provided final verbal
• 40:49feedback to an intern you've worked
• 40:51with for the last two weeks.
• 40:52In the fall, strengths were highlighted.
• 40:55You expressed you expressed some concern,
• 40:57however, though that they seemed
• 40:58to be putting in much longer
• 41:00hours than their peers,
• 41:01finishing notes late in the evenings,
• 41:03and making very late in the
• 41:04day phone calls to families.
• 41:06They were frequently yawning
• 41:08during rounds and falling asleep
• 41:09during midday didactics.
• 41:11So we want you to do the exact
• 41:13same thing with this last example,
• 41:15and you can preface it that you had
• 41:18a verbal discussion with this and
• 41:20then you kind of kind of maybe got
• 41:23different aspects of a differential
• 41:24diagnosis that came forward what
• 41:25was going on with the learner.
• 41:30I could prompt you here,
• 41:31but I think you guys are are
• 41:32going to do great creative stuff.
• 41:34So we'll give you a couple
• 41:36minutes to come up with a boss
• 41:39framework for this situation.
• 41:41This is your opportunity to kind of
• 41:43link a little more directly to verbal
• 41:46feedback and make sure it's aligned
• 42:03and it I should know,
• 42:04It's totally fine to write an
• 42:07observation and then say, you know,
• 42:10in discussion with the learner,
• 42:11you know it came up that you know,
• 42:14it seemed like this is what was
• 42:15at the root of the situation.
• 44:28Knowing you're all working at
• 44:30different speeds, we'll just
• 44:31invite you to There we go.
• 44:33We've got our first one coming in.
• 44:37It's an editorial comment. OK, thanks,
• 44:45Diana. Now it's just like saying,
• 44:46like, where it all goes bad is that people
• 44:49miss having the discussion and people jump
• 44:52to inferences about what they're seeing.
• 44:55And then they'll write down that they're
• 44:57disinterested and not and disengaged and
• 45:00not being respectful and all sorts of
• 45:02assumptions based on what they're seeing.
• 45:05But to Matt's point,
• 45:06there's this differential diagnosis.
• 45:07So you didn't get to explore it.
• 45:10So I just love keeping
• 45:12the the acronym in mind.
• 45:15Yeah. And I think,
• 45:18I think that's such an important point
• 45:21between the verbal and the written.
• 45:24The, the written is really quite limited,
• 45:27you know, compared to the verbal
• 45:29because we can't really explore
• 45:32the differential and we do need
• 45:35to be careful to not be making
• 45:37assumptions and what we're writing.
• 45:47So it's been a couple of minutes.
• 45:49We'll invite anyone who wants to go
• 45:52ahead and forward to us in the chat.
• 45:58You know, while people type,
• 46:02I have a comment.
• 46:03I have two caveats, one about the
• 46:05previous case and one about this one.
• 46:08You know, Kristen did a very good
• 46:10job talking about the iPhone case.
• 46:13I also pick up the same thing.
• 46:14But I also wanted to highlight
• 46:15something that I've come across,
• 46:16which is that not all iPhone use
• 46:20is evil and that especially now
• 46:23that we have Epic Haiku, you know,
• 46:26we're at risk of double messaging
• 46:27in a very serious way, right?
• 46:29We've made it really incredible for you to
• 46:31have Epic at your fingertips all the time,
• 46:34but don't use it.
• 46:35So I think that we need
• 46:36to be very aware of that,
• 46:37that there is quote UN quote
• 46:38good use and also good use,
• 46:40which I divided as patient related
• 46:42versus not patient related.
• 46:43So just a caveat for all of us,
• 46:44I know that I seen with my
• 46:47iPhone more than most.
• 46:49And the second thing in this is wearing my,
• 46:52perhaps my psychiatry hat.
• 46:53But I I'm sure that we've all dealt
• 46:56with residents or students or whatnot
• 46:58who have a lot of difficulty completing
• 47:01tasks and written tasks on time.
• 47:03And the more that we need to feed
• 47:05the beast of epic, the more so.
• 47:08And so I'm interested to,
• 47:10I was interested in,
• 47:11I'm interested in hearing
• 47:12what people will have to say.
• 47:13But something that happens often
• 47:15enough and yet we rarely talk about is
• 47:18that some of these folks can't do it.
• 47:20You know,
• 47:20there are learning disabilities.
• 47:22You know,
• 47:22being a physician doesn't make you
• 47:23immune to having a learning disability,
• 47:25a writing disability,
• 47:26to having ADD to having all sorts
• 47:29of things that are not only common,
• 47:31but they're horribly stigmatized.
• 47:32So you can be putting all of
• 47:34this feedback and just for us
• 47:36to be mindful of that,
• 47:38especially around written,
• 47:39which is such an important issue.
• 47:42Anyway,
• 47:48thanks. I just want to encourage
• 47:51anyone to put something in the chat,
• 47:53but we may be getting a message that
• 47:56not Nora just dropped
• 47:58something. Thanks, Nora.
• 48:01Oh, OK. Thanks. I can take that one.
• 48:04Thanks, Nora. Love how you use
• 48:08the letters to sort of guide you.
• 48:10That's what I find my colleague
• 48:12has been doing as well.
• 48:16So as previously shared verbally, Dr.
• 48:18Y has struggled with time management and
• 48:21maintaining boundaries around clinical work.
• 48:24This has in turn negatively
• 48:27impacted their ability to perform
• 48:29as they appear sleep deprived.
• 48:32We have discussed how to perform
• 48:34a root cause analysis. Oops.
• 48:37Somehow I'm not getting able to move my
• 48:44I I can take it.
• 48:44We've discussed how to perform a
• 48:46root analysis in their workflow to
• 48:48identify which is becoming consuming
• 48:50to continue to meet and review,
• 48:53where to prioritize the work and
• 48:54when to ask for help from colleagues.
• 48:56I encourage Dr.
• 48:57Y to continue in these efforts.
• 49:00Yeah, I think that's a,
• 49:02it's AI love the way you've linked it
• 49:04to the verbal feedback and you know,
• 49:07really then written it in a
• 49:10way that I think someone can
• 49:12carry forward in a helpful way.
• 49:16The significance is definitely there,
• 49:20it's turned, can negatively
• 49:22impact the ability to perform
• 49:25is is clearly significant.
• 49:27And then I think you offer some
• 49:31really nice suggestions as well
• 49:33about you know prioritizing the
• 49:35work and when to ask for help.
• 49:39So it's kind of like a a progress
• 49:42report almost at the end from what
• 49:44was said previously. So that's no
• 49:48except I forgot to continue.
• 49:52Yeah I love, I love these points
• 49:55about you know like continuing to
• 49:57come back and re engage with the
• 49:59issue and then you know I think
• 50:00a lot of physicians have a lot of
• 50:02trouble asking for help. So I think
• 50:05receptors and and mentors that
• 50:07are encouraging, you know,
• 50:09reaching out to others and asking for help.
• 50:11It's something we need to
• 50:12do better as a profession.
• 50:13So I I love that encouragement
• 50:15from a from a mentor.
• 50:18Anyone else want to put something
• 50:21in the chat We'll shift our
• 50:23focus here in a minute. All
• 50:30right.
• 50:33Well, maybe it's appropriate, Matt,
• 50:35to move on to our next slide.
• 50:40So we wanted to end by just having
• 50:43you all before you go take just a
• 50:46minute here to go ahead and scan and
• 50:48fill out the short evaluation for us
• 50:50so so we can know how to improve.
• 50:53So this is your first opportunity to
• 50:56practice written feedback in an official way,
• 51:00Boss them
• 51:04and but stay tuned, don't leave people
• 51:06because they have a little take home
• 51:08slide next and we can then go over
• 51:10any questions that you might have.
• 51:12Yeah. And I see John is putting in in
• 51:16the chat an example for us as well.
• 51:20So please take a minute to fill out
• 51:22the user boss for us and hold on
• 51:26just a second, we'll we'll kind of
• 51:27close things out with a summary.
• 51:32And I I want to thank
• 51:34Yvonne for also contributing
• 51:39and I like how in Yvonne's he kind of
• 51:43gave some reinforcement that you know
• 51:45he's encouraging not to take shortcuts
• 51:49and also kind of self-care
• 51:50not to overstretch ourselves.
• 51:58I think the last piece of on is like
• 52:01I know I think as long as this was
• 52:05like associated with some resources,
• 52:08right, Because I mean time management,
• 52:10task management, note taking techniques
• 52:12like this could be an overwhelming thing
• 52:14to recommend to somebody in isolation.
• 52:16But as long as you verbally provided
• 52:18them with some, you know a book,
• 52:20a website, something like that,
• 52:22then this would that would
• 52:23be that would be perfect.
• 52:26I'm also seeing John and Candela
• 52:28wrote one for us and what I'm loving
• 52:32about his is the observation.
• 52:34He actually lists examples of
• 52:37behaviors that might suggest
• 52:39fatigue or time management issues.
• 52:41And I can. I'm expecting John worked
• 52:45really hard to list those in a as
• 52:48non judgmental way as possible.
• 52:50Trying to make those objective
• 52:53late day calls, yawning,
• 52:56sleeping during didactic so,
• 52:59and giving feedback.
• 53:00I reported these observations
• 53:02and they explained having had
• 53:04a newborn at home
• 53:07and some other personal challenges.
• 53:11So I offered my willingness to to
• 53:14continue to support Doctor X and
• 53:16working through these changing patterns
• 53:19as well as to check in with them on
• 53:21these issues in the next few weeks.
• 53:24Yeah, so I wasn't I wasn't
• 53:26sure I was quite ready to.
• 53:28I felt like they needed to write more.
• 53:30But I just had some questions about it.
• 53:33And I guess my question for you is, you know,
• 53:37it seems like the person is working this out,
• 53:41but what are your recommendations for I
• 53:44I think that I wrote this note to make
• 53:48sure that to monitor the process so that,
• 53:51you know, the situation does
• 53:53improve and that this person is,
• 53:55you know, sort of adjusting to
• 53:57the changes in their life.
• 53:58So I wondered your recommendations
• 54:01for including this as a note?
• 54:04Or would you just not include it,
• 54:06'cause it seems like it's working out,
• 54:08but just monitor it in the future?
• 54:11What are your recommendations for that?
• 54:15I I would say that I mean in something
• 54:17that's so tied to a major life event.
• 54:19I mean I I think this is probably
• 54:24more verbal feedback appropriate
• 54:27that necessarily written feedback
• 54:30appropriate that my personal opinion.
• 54:31The other thing I also wanted
• 54:33to point out is that, you know,
• 54:34I think no matter who you are,
• 54:36you're going to come into situations
• 54:38where you may not have the answers.
• 54:40And right, like so many of the clinical
• 54:44preceptors at Yale are not great problem
• 54:47solvers when it comes to managing
• 54:49a newborn and a resident schedule.
• 54:52So I think, you know,
• 54:54reaching out to program directors GMEI
• 54:58mean trying to get reached like you,
• 54:59you can't solve,
• 55:00we can't solve all of our
• 55:03president's problems.
• 55:03And I I think you need to know when
• 55:05you've reached the limit of your
• 55:06expertise and when someone's in a
• 55:08better position to help somebody.
• 55:10Yeah, As I was writing it,
• 55:12I was thinking it as more a note to
• 55:14myself to remember to monitor the
• 55:17situation rather than something that I
• 55:19would begin the residents record. Yeah,
• 55:22I think if you were like a clinic
• 55:24preceptor and you're going to
• 55:25see them on a routine basis,
• 55:26that makes a lot of sense.
• 55:27You know, if you're if it was
• 55:29like a one time, you know,
• 55:30you were like their cardiology
• 55:31attending on a subspecialty rotation
• 55:33and might not apply as much.
• 55:35But I think in the right situation
• 55:37where you hadn't expected kind
• 55:39of recurring preceptor role,
• 55:41that really makes sense. John.
• 55:43I I agree. I think this is more
• 55:45suited for verbal probably.
• 55:47But I think at the same time it
• 55:50could be shifted into a a point in
• 55:54an evaluation about the person,
• 55:56how they were able to receive feedback,
• 55:59you know, how open they were
• 56:01to it and how they were able to
• 56:04act on it in a productive way.
• 56:06Sort of, yeah. Because that's those
• 56:08are our competencies too, right?
• 56:10You know, being able to receive
• 56:12feedback and implement change.
• 56:16I was
• 56:16thinking as sorry, Doctor Morrison,
• 56:19just a a related question to that.
• 56:20But I was thinking that maybe another
• 56:23person may make a a remark about the
• 56:25person's leaping yawning and not be.
• 56:28I was wondering if mentioning the
• 56:30newborn and mentioning the situation
• 56:31could be a way of us protecting that
• 56:34learner and explaining in the letter
• 56:35why that is happening and what measures
• 56:38they're taking to try to work around it,
• 56:40'cause maybe if we don't mention it,
• 56:42nobody else will and someone else
• 56:44might just say person is sleeping
• 56:46and then there's no explanation.
• 56:50Yeah, I think, I think Matt and I were
• 56:53agreeing both because we supervise,
• 56:55you know, our trainees as program director,
• 56:58roles that we would need to
• 57:00be aware of this for sure.
• 57:02So it would definitely be
• 57:04verbal feedback at some level.
• 57:07And then we would need to sort of coach
• 57:09them forward to be able to, you know,
• 57:12reveal what they're comfortable in
• 57:14the next learning setting so they
• 57:16can work on it in a productive way.
• 57:20I'm gonna move,
• 57:21just have our last slide here.
• 57:23Thank you all for the comments
• 57:25and for for jumping into our
• 57:27hopefully safe and brave space,
• 57:29putting yourselves out there
• 57:31and trying out the BOSS model.
• 57:34I think we wanted to just
• 57:36remind all of us that you know,
• 57:38doing feedback whether
• 57:39it's verbal or written,
• 57:41but specifically if you're going
• 57:43to do a written evaluation,
• 57:45doing it sooner is always better
• 57:47because you can be more specific and
• 57:49and target your words to what actually
• 57:53just happened and and not forget.
• 57:55So always proximal,
• 57:57a reminder that feedback can
• 58:01really fall into sort of different
• 58:04categories of appreciation,
• 58:06coaching and evaluation.
• 58:08So maybe being clear with yourself
• 58:11kind of which mode you're in,
• 58:14Please carry forward the BOSS
• 58:16framework in whatever way it's
• 58:18going to be helpful to you.
• 58:19Think about milestones or,
• 58:22you know,
• 58:23developmental milestones or
• 58:25educational program objectives as
• 58:28ways that we can anchor our feedback.
• 58:31Be specific, you know,
• 58:33be as specific as possible always,
• 58:35but especially in your suggestions
• 58:39for improvement.
• 58:40Make sure that the written aligns
• 58:42with the verbal as best we can,
• 58:45and always complete.
• 58:46Consider completing the verbal and
• 58:49written together certainly at the
• 58:51end of an experience at the end of a
• 58:54rotation or at the end of a course.
• 58:57And Matt is thanking people as well.
• 59:01So we'll end there and welcome
• 59:03any additional questions we'll
• 59:04stay but we're we're already
• 59:06at the end of our time.
• 59:08I I just want to add that there's
• 59:11some upcoming talks listed here.
• 59:13The upper right QR code is the
• 59:15Yes series and allows you to
• 59:17register for future events.
• 59:19And then if you're interested in any of
• 59:21the videos or articles we referenced,
• 59:24the lower right QR code is a
• 59:26PDF document of both those video
• 59:29links and the article links.
• 59:32But thank you so much for coming and
• 59:35participating and this was really,
• 59:37this was really great and generative
• 59:41and last little plug for that,
• 59:42especially the well both
• 59:43Andre's session on the posters,
• 59:45but Katie Gilson's session also
• 59:47about bias which could dovetail
• 59:49into additional considerations as
• 59:50we're as we're writing some of the
• 59:53feedback and giving feedback sets.
• 59:55Good pairing.
• 59:56Thank you so much both of
• 59:59you and everyone for coming.
• 01:00:01Happy Friday, everyone.
• 01:00:02Yeah, Happy New Year.