How to Give Feedback

Review the subsections by clicking on the buttons below.

How to Give Feedback

Feedback is an ongoing process that occurs throughout the student's time with you. The "IMPROVE" strategy (see Table 1) can help you set expectations with your student, assess the student's performance, and provide information to the student in a manner that encourages improvement.

Table 1 : IMPROVE Model
I · Identify rotation objectives with the student
M · Make a feedback friendly environment
P · assess Performance · Prioritize the feedback you provide
R · Respond to the student's self-assessment
O · be Objective: report specific behaviors observed; · describe potental outcomes of behavior
V · Validate what the student has done well or suggest alternative strategies
E · Establish a plan to implement changes (if needed) · Have the student summarize feedback and the plan

Here are a few additional things to do to present feedback to your students in a positive manner:

  • Prepare your student so (s)he knows you will be providing feedback. If possible, this should have been done during the student orientation.
  • Provide feedback in private.
  • Focus on behaviors that the student can change; do not address personal attributes.
  • Provide specific information to the student. Vague comments, e.g. "You did a good job," "You did a poor job," are not useful to the student.
  • Base your comments on observed or objective information, not hearsay. If possible, provide objective evidence for your comments.
  • If you decide to provide subjective feedback to your student, label your subjective feedback so the student knows this is what it is.
  • Consider using the "feedback sandwich," e.g. place positive feedback on either side of negative feedback so you begin and end on a positive note. If you use this approach, be wary of using the same technique all of the time. Students often figure out the pattern and they begin to discount the positive feedback as "sugarcoating" of the criticism.

Teaching Hints:

Here are a few hints about how to discuss feedback during your orientation with the student.

  1. Describe your feedback process and discuss with the student when feedback will be given. For example, will you be providing feedback in response to case presentations or directly observed encounters? Will the feedback process be conducted "on the fly," during debriefings at the end of each day, or in weekly reviews?
  2. State whether other providers and office staff will provide feedback as well. Nurses and receptionists may see a different side of the student or see the student engaged in different tasks.
  3. Ask about the student's prior experiences with feedback. Were they positive? Negative? Keep these experiences in mind as you provide your feedback.

I — Identify Rotation Objectives with the Student:

The first step in providing feedback is to prepare your student. To facilitate a smooth feedback process, set expectations with your student early in the rotation regarding the content that will be assessed and the process you will use to give feedback. Taking time at the start of the rotation to clarify what you expect of your student will ultimately save you time.

During your initial orientation session with the student (Module 1), discuss the rotation objectives and your expectations of the student.. Together, set specific, mutually-agreeable rotation objectives. This will help to identify content to be addressed through your feedback.

On your notepad, note the feedback process you want to take with your students.

M — Make A Feedback Friendly Environment

The following list outlines ways to create an environment that facilitates the feedback process.

  • Show your interest in the student's education. Ask about his or her background and future career goals, and identify linkages between the rotation and these goals. Students are less likely to feel threatened by feedback from someone who is supportive.
  • Let the student know that you and the student are partners working towards a common goal of expanding his or her clinical knowledge. Seek the student's input as you discuss objectives for the rotation and as you assess his or her performance.
  • Show your interest in what the student does well as well as what he or she can improve. Because some students only associate feedback with criticism, it is a good idea to make your initial feedback positive.
  • Show that feedback is a natural part of the clinical experience. Let the student see you giving and receiving feedback from colleagues, staff, and patients. Regularly ask for the student's feedback about your precepting and the rotation.

P — Assess Performance

Directly observing the student working with a patient is one of the best ways to assess the student's knowledge, skills, and attitudes. Clearly, this is an additional demand of your time. However, the assessment information it can yield is invaluable since we often do not know what is actually taking place in the examination room. Patients and students are likely to feel more comfortable with your presence in the exam room as you observe the patient/student encounter if you tell them about this teaching strategy in advance.

A secondary means of assessing student performance is through the student's patient presentations (see Module 7 for a discussion of the One-Minute Preceptor approach). Your active participation and questioning in this process can determine potential gaps in the student's knowledge base, as well as potential issues related to clinical and interpersonal skills

Teaching Hints

When providing feedback, it is particularly important to pay attention to the timing of the feedback. It is best to provide feedback immediately following an encounter, while the experience is still fresh in the student's mind. However, if the student is feeling rushed, upset, or otherwise distracted, he or she may not be able to concentrate on the feedback. In this case, you might tell the student you have some feedback and suggest a time to talk later in the day.

P — Prioritize What Feedback to Give

Although quality feedback is a good thing, too much feedback at once can be overwhelming and it will be difficult for the student to retain it and integrate it into his or her behavioral patterns. As a result, it is important to prioritize the feedback you provide the student. In general, it probably is best to provide two or three main points during any given feedback encounter.

In addition, be sure to focus your comments on behaviors that will improve the student's future performance. For example, saying to a student,

"You seemed really nervous in there - you were fidgeting a lot and your questions were all over the place"

may not help the student, unless you add some specific suggestions for how he or she might act differently in the future. As an alternative, you might say,

"Take a few deep breaths, relax, and focus on getting to know the patient. Then focus on characterizing the symptoms."

Some behaviors are easier to change than others. For example, a student's quiet nature or accent is not going to change overnight. However, if it is inhibiting communication with the patients, it is important to address. A student cannot change a youthful appearance, but might benefit from suggestions about how to demonstrate confidence and maturity if his or her young appearance seems to disconcert patients.

R — Respond to Student's Self-Assessment

Before you share your assessment, it can be helpful to have the student assess his or her own behavior during the encounter. Students are less likely to be defensive if they have an opportunity to critique themselves first, and you can incorporate their observations into your feedback. This method also gives you a sense of the student's self-assessment skills.

For example, you might say,

"Let's talk about how that visit went. What did you like about your history and exam (or case presentation, or rapport with the patient)?"

Student responds. Then you can ask.

"What would you want to do differently next time?"

Students will often defer to your assessment, they may talk about their behavior in general terms (e.g., "I thought my exam was thorough."), or they may describe what the patient contributed to the encounter (e.g., "The patient presented her history readily - She was an easy patient."). Encourage the student to assess him- or herself first and to focus on his or her own behavior in the encounter.

O — Be Objective

When you base your feedback on direct observations of the student, there is less room for inferences and interpretations than when you report what you have heard from someone else.

As you begin to provide feedback about an encounter, describe the specific action(s) you observed, without any interpretation of the student's assumptions or intentions.

Teaching Hints

An alternative to this approach also may include asking the student for his or her self-assessment of the encounter. Keep the student self-assessment strategy in mind as you decide how you want to handle your feedback session with the student.

V — Validate Positive Behaviors or Suggest Alternative Strategies

During the feedback encounter, it is important to reinforce positive behaviors and, when appropriate, suggest alternative behaviors. Again, providing specific information is critical to this process.

For example, if you are providing constructive suggestions to a quiet, reserved student who is having trouble developing rapport with patients, you might say,

"You took a lot of notes during the history and did not have much eye contact with the patient. You also did not ask any questions about her home life, or follow up when she said that she had been feeling stressed lately."

"Reaching out to your patients involves asking personal questions. Next time, try to focus on developing good eye contact, smiling, and asking about their interests and activities. These things may help you feel as though you are able to develop more of a rapport with your patients."

E — Establish a Plan

Finally, when providing feedback, it is helpful to make a plan to improve the student's performance in a weak area and to have the student summarize the feedback and the plan. Some questions you might ask yourself may include:

  • What does the student need to learn or do differently next time?
  • What strategies will help the student acquire this knowledge or change their behavior?

For example, in a case where you are providing constructive feedback to a student whose case presentation of a 9-month-old with diarrhea and vomiting did not include a discussion of symptoms or an assessment of dehydration, you might assess the student's knowledge of the diagnosis and management of dehydration in children. If you feel as though there are some gaps, you might say,

"I'd like you to read tonight on the diagnosis and management of dehydration in children and present it to me over lunch tomorrow. In particular, I'd like you to review the different states or degrees of dehydration and how a baby would look in each of them. Also, what criteria would you use to select between different treatment options?"

Module 4: Providing Feedback