Questions about feedback
Answer to "How can feedback impact performance and encourage behaviour change?"
Feedback is essential for performance improvement and professional growth. In the era of competency-based training and assessment, learners need timely feedback on their performance to develop and reach expected goals.In this light, thinking about providing feedback as coaching for development and improvement can be helpful. Several benefits of feedback have been described for professionals at all levels.
Benefits of effective feedback include:
Calibration of current performance. Learners can access accurate information about their current performance from multiple external sources such as teachers, peers, other members of an interprofessional team, patients. When external data are added to self-assessment data, current performance can be more accurately calibrated.
Estimation of the gap between current and expected performance. Feedback provider-recipient conversations are most effective if current performance in specific domains is compared to expected outcomes to identify a potential gap. Once this gap is discussed, strategies to close the gap can be discussed. This is an essential feature in competency-based medical education.
Reinforcement of strengths. Learners need validation and reinforcement of strengths so that they are aware of what they are doing well and behaviours that should be continued To achieve this, feedback providers need to provide specific observations about and define the behaviours that are viewed as strengths rather than the typical, ‘good job’ comments.
Internal motivation to improve competence. Feedback conversations that include not only reinforcing remarks, but also description of gaps in performance along with a road map to close the gap and get to the next level, in a supportive manner which seeks the learner’s input, can enhance self-efficacy, competence and autonomy. All these, in turn, will drive internal motivation of learners.
Reflective practice. Asking open questions of learners about their performance and their perspectives on how best to improve, in a respectful manner, fosters their ability to critically reflect. As teachers facilitate learner reflections on performance, discuss areas of strengths and areas for improvement, help learners formulate action plans for improvement and foster ongoing self-assessment, they can promote learners developing into reflective practitioners who embrace lifelong learning.
Anderson, P. A. M. (2012) ‘Giving feedback on clinical skills: are we starving our young?’, Journal of graduate medical education, 4(2), pp. 154–158. https://doi.org/10.4300/JGME-D-11-000295.1.
Ende, J. (1983) ‘Feedback in Clinical Medical Education’, JAMA, 250(6), pp. 777–781. https://doi.org/10.1001/jama.1983.03340060055026.
Norcini, J. (2010) ‘The power of feedback’, Medical Education, 44(1), pp. 16–17. https://doi.org/10.1111/j.1365-2923.2009.03542.x.
Sargeant, J., Armson, H., Chesluk, B., Dornan, T., et al. (2010) ‘The Processes and Dimensions of Informed Self-Assessment: A Conceptual Model’, Academic Medicine, 85(7), p. 1212. https://doi.org/10.1097/ACM.0b013e3181d85a4e.
Tekian, A. (2017) ‘Are all EPAs really EPAs?’, Medical Teacher, 39(3), pp. 232–233. https://doi.org/10.1080/0142159X.2016.1230665.
Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., et al. (2006) ‘Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7’, Medical Teacher, 28(2), pp. 117–128. https://doi.org/10.1080/01421590600622665.
Watling, C., Driessen, E., van der Vleuten, C. P. M., Vanstone, M., et al. (2013) ‘Beyond individualism: professional culture and its influence on feedback’, Medical Education, 47(6), pp. 585–594. https://doi.org/10.1111/medu.12150.