I am going to switch it up and give a TR pearl on a “hidden curriculum” skill – How to deliver effective feedback. This is loosely based on an EMRA Education Committee feedback workshop that we held at ACEP.
Feedback is an essential part of any professional field but can be challenging to provide and receive. Whether you are a 1st year resident providing feedback to medical students who are rotating in the Emergency Department or a 3rd/4th year resident providing feedback to junior residents in the Trauma bay or on Acute 2/A-Side, feedback can have the greatest impact on learning. We need feedback because objectively we are not the greatest at assessing our own performance. Therefore, we need to develop the ability to provide and receive feedback effectively.
Tl;Dr Pearls – <5 minutes
Feedback should be: Expected, Timely, Specific, Actionable, Concise/Limited in quantity
Tools to deliver effective feedback: SHARE, SOAP
Extended Pearls – >5 minutes
Guidelines to deliver effective Feedback:
1. Feedback should be expected: Set the stage when giving a learner feedback. At the beginning of shift, let the learner know that you will be giving feedback either during the shift or at the end of shift. Ask the learner to also self-reflect on what they would like to specifically receive feedback on (i.e improvement of workflow, H&P, procedures, documentation, etc..) This allows the learner to 1.) Be less caught off guard when they receive feedback 2.) “Self-Assess” themselves throughout the shift.
2.) Feedback should be timely: In every moment you seen an opportunity (with some exceptions – i.e in the middle of a cardiac arrest), you should provide feedback so it can be directly applied to the next encounter
3.) Feedback should be specific: It is very important to give a learner tangible points that can be easily incorporated to their next procedure, patient encounter, or shift. Instead of “You just need more practice/experience when placing a USGIV,” you can specifically say “I observed that your position was the biggest hindrance to this procedure. Next time, try lifting the patient’s bed, placing the ultrasound machine on the opposite side, lowering the guardrails, etc..)
4.) Feedback should be actionable: Before you give feedback, ask yourself if this is something the learner can actually incorporate into their workflow. In addition, ask yourself if the feedback is something that I can assess the next time I am observing the learner?
5.) Feedback should be concise/limited in quantity: When giving feedback, be mindful of giving the learner only 1-3 points that are tangible. When a learner is overwhelmed from a high quantity of feedback, it often rarely gets internalized.
Different tools you can use on your next shift to give feedback:
Situation: What was going on?
What Happened: What they did and the impact?
Action: How to improve in the future
Relationship: I’m giving you feedback because….
Explore: Check for questions, reflections, or ideas
Subjective: Listen to the learner first – ask in general, then in specific – “How did it go” then “what went well/what would you have done differently.”
Objective: Building on what the learner says, describe one or two examples that went well/didn’t go well
Assessment: Continue to do more of this…., Do less of this….., Change this….., This gives you an opportunity to reinforce good behaviors and provide a platform to change bad behaviors
Plan: Based on the feedback session, ask the learner of what their action items are for the next procedure, patient interaction, shift.
Disposition: Don’t forget to ask the learner for feedback…on your feedback! Giving feedback is a skill that needs feedback from the learner for self-improvement.
Dr. Christina Shenvi, (2022). How to give and receive feedback well [ACEP 2022, San Francisco]