MEDICAL EDUCATION
Notes for the Primary Care Teachers
GIVING FEEDBACK
SB Khoo FRACGP
Penang Medical College, Penang, Malaysia
Address for correspondence: Dr Khoo Siew Beng, Department of Family Medicine, Penang Medical College, No 4, Sepoy Lines Road, Penang 10450, Malaysia. Tel: 604-2263451, Fax: 604-2284285, E-mail: sbkhoo@pmc.edu.my
Khoo SB. Giving feedback. Malaysian Family Physician. 2007;2(1):27-28DEFINITION
Feedback refers to information describing trainees’ performance in a given activity.1 Giving feedback means letting them know, in a timely and ongoing way, how they are performing.2 If in doing this, one is able to change the general method and pattern of performance, then we have a process termed as Learning.
IMPORTANCE OF FEEDBACK IN MEDICAL EDUCATION
Many diverse methods of instruction are used throughout a training experience but the most available and influential method of learning is feedback. The attending physician observes how the trainee performs history or physical examination, presents a case, makes decision about patient’s therapy or interacts with other members of the medical team. He then provides insight to the trainee to highlight the disparity between the intended result and the actual result thereby providing impetus for change.
When used properly feedback can be a powerful tool in clinical medical education. It involves an aspect of the clinical process not readily examined by tests of cognitive skills. It conveys an attitude of concern for the progress and development of the person in a real sense, not only as a function of grades or test scores.1
Without feedback mistakes go uncorrected, good performance is not reinforced and clinical competence is achieved empirically or not at all.
NATURE OF FEEDBACK
Feedback is immediate information that is designed to influence, reinforce or change behaviour, concepts or attitudes. It may include the words used, body language, specific actions and decisions that have been made but it does not interpret behviour.3
allows clarification, disagreement and learner “buy in” to objectives and plans of change.3
Feedback is a modifier of behaviour but not estimate of personal worth. The wise learner welcomes it, uses it effectively and learns to develop self reflection and self awareness to plan for future learning and practice. Feedback should not lead to anger, defensiveness or other emotions.3
Differences between feedback and evaluationFeedback is an ongoing formative process that allows trainee to reach a goal while remaining on the course while evaluation is a summative process that comes after the fact how well or poorly the trainee has performed. Feedback presents objective appraisal of performance intended to improve clinical skills but not judgment or interpretation of behaviour. Evaluation presents information and judgment with intended estimate of a trainee’s personal worth.
Barriers to provision of feedback
Teacher may be concerned that the learner will be hurt by negative feedback, that it will result in more harm than good, that it will damage the learner-teacher relationship or the teacher’s popularity. Anxious about the impact of their information on the trainee, but committed to the need for feedback, the well intentioned teacher may talk around the problem or use such indirect statements as to obfuscate the message entirely.1
Learners may view feedback as a statement about their personal worth or potential. They may want information about their performance but in so far as it confirms their self-concept. Fearing a negative evaluation, the learner may support and reinforce the teacher’s avoidance. It appears that learner satisfaction is not an accurate measure of the quality of feedback. Satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.4
