Supporting health students in the workplace

Module 4: Constructive feedback

OBJECTIVES

• Develop an understanding of the ways to deliver effective feedback
• Determine what constitutes constructive versus destructive feedback

Feedback is the information given to a person about their performance which is used as the basis for improvement (2013, Oxford Dictionary). It is given in relation to the standard the job requires. It is an essential component of any learning environment. Constructive feedback is motivational and encourages continued learning and development. It provides information about behaviour and encourages the student to reflect upon practice. It identifies the strengths and areas for focus in the student and builds confidence in skill development. It provides direction and clarity of purpose.

Preparing for feedback:

When preparing to give feedback, all relevant information should be collected so that all the facts are available. The clinical supervisor / preceptor must be familiar with the standard that is required and the individual objectives to ensure that the learner is being assessed fairly. The clinical supervisor / preceptor should be properly prepared for the session including:

• Identifying and minimising any personal bias or pre-conceived impressions
• Predict the learners’ likely response
• Contemplate possible solutions
• Allow time to give feedback
• Provide a private setting

Guidelines for giving feedback:

Feedback should be:

• Selective
• Specific
• Timely
• Descriptive
• Sensitive
• Creative.

Consider patient safety as a guideline in deciding when feedback is appropriate. For example, if a vital step has been missed during a procedure, ensure you intervene immediately by prompting the student to act:

“Andrew, when would be the time to perform your hand hygiene”.

When giving feedback, always maintain positivity throughout. As adult learners, it is essential that the student is given the opportunity to reflect upon their own performance and identify strengths and weaknesses themselves (See The Sound of Leadership and Management).

“So Andrew, how did you find that activity?.... What worked well for you?.... What would you do differently next time?”

With the appropriate insight, this allows the student to self-correct their practice with minimal intervention from the clinical supervisor / preceptor. The clinical supervisor / preceptor needs to select a few key areas to focus on during feedback to ensure the student is not overwhelmed. So although you may have found the whole performance to be sub-optimal, identify just a few things to concentrate on.

“I’m really pleased you identified communication as being something you could work on. I think if you approached the patient using different body language and tone, you would be able to connect with the patient and uncover so much more than you did today”.

Ask for clarification to ensure comprehension and ensure that you offer solutions. Never put off giving feedback to the end of the shift or next shift as it will lose its impact / effectiveness. Always ensure the student knows there are solutions and a pathway through their problems to ensure they remain positive and focused. The Golden Rule of feedback: “if I have done well, reward me. If I have done badly, tell me but let me know I have the capacity to make it next time” (Hunt as quoted in Horner 1995)

Performance counselling:

Performance counselling involves talking with a learner after ongoing feedback has been provided about issues relating to their performance or behaviour. It is a means of problem solving and working out alternative approaches that may assist the learner to improve performance. It is not a disciplinary procedure and should not be confused as such.

There are 3 phases of performance counselling:

1. Preparation: Gather all facts and any evidence. Consider how the person will react and think of possible rebuttals and responses they may offer and then provide possible solutions to these. Ensure you have identified any personal bias that may cloud your judgement.
2. Interview: Ensure that interruptions are minimised for the duration of the interview. Allow the learner to describe what went well and why? What was challenging and why? What they might do differently next time? Help them to establish the learning / knowledge gap and the possible causative factors. Help the learner make the necessary links to previous lessons learnt and identify possible solutions that may help the situation. Document them clearly and objectively.
3. Follow-up: Ensure you arrange to meet with the learner again to establish the effectiveness of your plan.

Common counselling errors include:

• Not clearly defining the behaviour required
• Neglecting to provide regular or effective feedback to the learner
• Delaying performance counselling
• Lack of preparation
• Not having control of the interview
• Being aggressive or compliant rather than assertive
• Not allowing the learner to talk
• Failing to actively listen
• Not establishing the cause of the problem
• Not setting an agreed plan of action.

The take home message for the delivery of constructive feedback is:

• Remember to assume an empathetic approach to your role. Give regular constructive feedback and be clear in your language.

Delivering constructive feedback is difficult and not always fun. However, it can be rewarding. People will surprise you. Some will react more negatively than you anticipated. Others will surprise you by being grateful for the feedback, and you will feel proud when you see them grow. You are responsible for all learners and for them being able to work successfully as a team. It is important to give individuals feedback and hold all of them to the same standards. When you don't address behavior or performance issues, not only can staff lose faith and trust in you as a leader, they may think it's OK to behave that way as well (Blatchley, 2017).

There are three types of conversations to effectively feedback to students depending on the type of engagement required.

• Non-confidential directions requires a low energy level, requiring a casual conversation or short comment. It can be a brief exchange in a relatively public area and is useful for highlighting a possible clarification of policy or clarification of a question.
• Confidential discussions require a private area to discuss an underlying problem or behavior. The exchange is initially information gathering followed by an attempt to offer perspective for the student in relation to their understanding of the problem/behavior being discussed.

A Supportive conversation is a discussion to identify whether the student is working in the correct environment and to provide them with more satisfaction. This can be particularly useful when the student may need another working environment because of perceived or real conflict in the workplace. Finding a satisfactory solution will help the student strive in the workplace and is necessary for their professional growth (Blatchley, 2017).