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Reduced to tears and triggering defense
mechanisms:
How to provide effective, meaningful verbal feedback and
create learning opportunities
Leah Delfinado, MDAssociate Program Director
Department of Obstetrics and GynecologyAdvocate Illinois Masonic Medical Center
No disclosures
Qui tacet consentit
Objectives•Why feedback is important•Types of feedback•Barriers to giving and receiving feedback•What does meaningful feedback look like•Practice makes perfect
Why feedback is importantCritical assessment toolEmphasizes reflective capacityFosters professional autonomy
Informal vs Formal Assessment
Barriers to giving feedback•Fear of upsetting the trainee•Trainee is resistant or defensive
Barriers to Receiving Feedback•Feedback is too generalized and not related to
specific observations•Feedback does not give guidance to rectify the
behavior•Inconsistent feedback from multiple sources•Lack of respect for the source of feedback
Giving Effective Feedback•Immediate•Private•Interactive•Behavior focused, not personality based
• Present behaviors, not old ones• Give examples• Don’t assume motive• Offer alternate behaviors
Giving effective feedback•Consider your message; 2-3 key points•Consider the impact•Focusing on overall learning and development within
residency, keeps the overall message positive•“Sandwiching” information often feels disingenuous
Giving Effective Feedback•Encourage self reflection• “What do you think you did well?”• “What do you think you can improve upon?”
• May be particularly effective for those trainees you view as defensive
Scenario 125yo G1P0 GDM, with poor labor curve delivers a 4200g infant with a 1 minute dystocia at 1am. The PGY 1 pushed with the patient for 90 minutes in the room by herself then called the attending physician when the patient was crowning. The attending took over (when the intern failed to perform any maneuvers) performing a Woods screw with McRoberts and suprapubic pressure.
What feedback would you really
like to give?Person A is a senior resident, comfortable with
and often asks for feedback. Person B is an intern, clearly uncomfortable with feedback and self conscious with your
supervision of their performance.
Scenario 2You’re assisting a resident with a speculum exam and pelvic exam on a 21yo nullip for her first gynecological visit. You notice the patient is extremely nervous, and she has a hard time tolerating the exam. The resident has 3 other patients waiting at the clinic, hurries through the exam with little communication, and the patient appears to be upset afterwards. The resident leaves the room without addressing the patient’s distress.
Feedback?Person A is someone you’ve given feedback to
in the past, and they appeared defensive.Person B is a junior resident who has already
been given feedback today by their senior resident, and that exchange ended in tears.
Goals of Effective FeedbackMotivateDevelop knowledge, skills, behaviorsMaximize potentialRaise awareness of strengths and weaknessesIdentify techniques to improve
Questions, Comments...
Or Feedback?