Does mapping to SNOMED CT improve precision of subjective clinical evaluations ?
“My clinical evaluations are so subjective!” - ACP · PDF filePractice writing a...
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Stanford Faculty Development Center 2016
“My clinical evaluations areso subjective!”
Evaluating Learners and Writing Helpful Clinical Performance Narratives
Part 2: Feedback
Julie A. Vannerson, MD, FACP
T. Robert Vu, MD, FACP
Jack D. Buckley, MD, FACP
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Stanford Faculty Development Center 2016
COI Disclosures• None to report
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Learning Objectives Explain teaching cycle
Define Feedback
Describe characteristics of effective feedback
Define levels of feedback
Practice writing a clinical performance narrative
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Teaching Cycle
Communication of Goals
Evaluation
Feedback
Learning Climate
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Communication of Goals
Knowledge
Skills
Attitudes
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Communication of Goals Definition
Establishment & explicit expression of teacher’s and/or learner’s expectations for learner
Function
Let learners know what to master
Guide teacher in planning instruction
Provide learners & teacher with basis for evaluation
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Evaluation
LEARNER
CONTENT
TEACHER
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Evaluation Definition
Evaluation is process by which teacher assesses learners' KSA, based on criteria related to educational goals
Types Summative
Formative
Methods Observation
Questioning
Self-assessment
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Stanford Faculty Development Center 2016
Teaching Cycle
Communication of Goals
Evaluation
Feedback
Learning Climate
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Difference between EV & FB
LEARNER
CONTENT
TEACHER
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When I Say Feedback, You Say…
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Why is Feedback Hard?
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Feedback
LEARNER
CONTENT
TEACHER
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Feedback Types Two Sides of the Same Coin
Evaluation Feedback Formative
Occurs throughout teaching/learning process
To assess learner’s progresstowards educational goals
Summative
Final assessment of learner’s performance at the end of a learning experience (course, rotation, etc)
Formative Given throughout teaching/learning
process; commonly at mid-point Typically verbal Not linked to a grade/final decision Meant to improve performance
Summative Final report at end of a learning
experience Narrative comments typically
required May be linked to a grade/final
decision about advancement Meant to improve performance
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Effective Feedback1. Pre-work
2. Specificity
3. Focus
4. Frequency
5. Timing
6. Positive/Negative
7. Learner reaction
8. Action plan
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Stanford Faculty Development Center 2016
Effective Feedback1. Pre-work
2. Specificity
3. Focus
4. Frequency
5. Timing
6. Positive/Negative
7. Learner reaction
8. Action plan
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LC
Feedback
CG
EV
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Stanford Faculty Development Center 2016
Effective Feedback1. Pre-work
2. Specificity
3. Focus
4. Frequency
5. Timing
6. Positive/Negative
7. Learner reaction
8. Action plan
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LC
Feedback
CG
EV
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A Word About Specificity Descriptive
Related to behaviors set forth in goals
Observable, behavior-based
Directed toward remediable behaviors
Avoid assessments of personal characteristics (quiet voice, stuttering, etc.)
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LC
Feedback
CG
EV
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Stanford Faculty Development Center 2016
Effective Feedback1. Specificity
2. Focus
3. Frequency
4. Timing
5. Positive/Negative
6. Learner reaction
7. Action plan
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LC
Feedback
CG
EV
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Levels of Feedback Minimal feedback
Behavioral feedback
Interactive feedback
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Minimal Feedback Teaching behaviors
Tell learner that performance is correct or incorrect
Agree or disagree with learner’s opinions
Use nonverbal cues like nodding
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Minimal Feedback Formative feedback examples
“No”
“That’s correct”
“I disagree”
Summative feedback examples
“X did an excellent job. He is a pleasure to work with.”
“Good job”
“Solid student”
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Behavioral Feedback Teaching behaviors
Describe learner’s performance as behaviors
Tell learner why performance is correct or incorrect
Give reasons for agreement or disagreement
Offer behavioral suggestions for improvement
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Behavioral Feedback Formative feedback examples
“During rounds, you frequently interrupted the other team members.”
“Your choice of antibiotic dose is correct because it is adjusted for his creatinine clearance”
“I disagree with your discharge plan for his diabetes because it requires him to self-titrate his insulin. It would be safer for him to wait until he sees his PCP for titration”
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Behavioral Feedback Summative feedback examples
“Very hardworking, arriving early and willing to stay till the work is done.”
“Had a cursory knowledge of clinical pharmacotherapy in the patients he saw, often having difficulty generating a list of the most common and most dangerous side effects.”
“Knew how to recognize with her clinical exam the difference between a patient who was stable and a patient who was decompensating.”
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Interactive Feedback
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LT & L
CONTENT
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Interactive Feedback Teaching behaviors
Give learner FB (minimal/behavioral) then have learner self-assess
Have learner self-assess then give FB on ability to self-assess
Give learner FB on performance then elicit learner’s reaction
Develop an action plan with learner
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Interactive Feedback Techniques Ask-tell-ask
Pendleton model
Reflective feedback conversation
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Ask-Tell-Ask Ask learner to assess own performance
What is learner’s insight into own performance?
Tell learner what you observed
Include both positives and negatives
Ask learner if they understand
Ask for alternative behaviors
Make suggestions
Make a plan for monitoring
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Konopasek L, Bar-on M, Ask-Tell-Ask: A Tastier Feedback Sandwich.
http://www.acgme.org/Portals/0/PDFs/2015%20AEC/Presentations/ses039.pdf
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Ask-Tell-Ask Pros?
Cons?
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Pendleton Model Ask learner to state what was good about own
performance
Provide positive feedback
Ask learner to state what could be improved about own performance
Provide negative/corrective feedback
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Pendleton D, Schofield T, Tate P, Havelock P. The consultation: an approach to learning and
teaching. Oxford: Oxford University Press, 2003.
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Pendleton Model Pros?
Cons?
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Reflective Feedback Conversation Ask learner to share any concerns about recently
completed performance
Ask learner to describe concerns & what they would have liked to have done better
Tell learner views on performance of concern & offer support
Ask learner to reflect on what might improve situation
Elaborate on learner response, correcting if necessary, & check for learner understanding
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Reflective Feedback Conversation Pros?
Cons?
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Your Turn for Feedback Watch the video clip
Spend 5 minutes writing
Debrief
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Why is Feedback Hard?
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