Teaching Hints

Students often report that they do not get enough feedback from preceptors (refs). In addition, students often do not recognize the information preceptors share with them as feedback. It can help to explicitly label comments as such. For example,

"To give you some feedback, I thought your case presentation was concise and I liked how you focused on the relevant history. On the other hand, a neurologic exam did not seem warranted. Next time, consider conducting a focused physical exam, just as you focused your history."

Barriers to Giving Feedback

Before you proceed with this section, list the main barriers that keep you from providing feedback to your students in your notebook:

There are a variety of barriers that can prevent us from providing feedback to our students. In reviewing the following statements, think about whether any of these are found on your list.

"Students already know how they are doing."

Surprisingly enough, students often do not know how they are doing. When people are first learning new skills, they do not have the experience or context for judging their own performance. What may be obvious to you, an experienced clinician, may still be unclear to a student.

"The behavior I am seeing is an anomaly."

Sometimes, you may notice behavior that is potentially troubling, but you are not sure the student consistently exhibits it. Since many of us don't want to make an issue of something if it is truly unwarranted, the easiest tendency is to not say anything. This may be particularly true at the beginning of a rotation when we don't know the student.

If possible, check with colleagues and staff to determine if they have observed similar behavior. It is okay to respond when you first notice the behavior and raise the issue with the student immediately - it is easier to prevent a potential problem than curb it once it has fully developed. However, you also want to be sure to do this with tact. For example, you can say,

"I don't know that this is something you normally do, but in this case, I noticed that you..."

Or, you can ask the student for a self-assessment and see if this behavior is addressed by the student.

"I don't have enough time to provide feedback."

Feedback does not need to take a lot of time and it is essential in helping students improve. At the end of this module, we will discuss specific strategies you can use to integrate feedback into your busy office setting.

"Providing feedback is awkward and it will make my student defensive."

Many of us, in our medical training, did not receive very much feedback. Or, the feedback we received may not have adequately acknowledged our skills or included strategies to improve our weaknesses. For those of us who experienced this, it is understandable to think that students are likely to be defensive in a feedback situation. The following "IMPROVE" feedback approach may take away some of the mystery and sense of awkwardness you may have when providing feedback to your students.

"Feedback will hurt my relationship with my student."

There is no way around it, providing feedback can open up the possibility of the student reacting to you negatively. However, if feedback is provided in a context where the student understands that you are trying to help and in a manner that does not put the student on the defensive, it can actually deepen your relationship with the student.

Module 4: Providing Feedback