Feedback

teaching and learning toc =Feedback = This page will focus on verbal feedback rather than written/electronic feedback. Although some of the links come from a clinical setting, feedback can be just as valuable for all other outdoor skills.

When thinking about feedback we usually have an individual learner in mind. When learning is taking place if groups, though, then feedback can be provided to the group. There is overlap between feedback and debriefing (aka after action review).

What is feedback? Definition (in clinical practice)

 * ‘Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance//.//’ **



Feedback is not the same as criticism - that is highlighting deficiencies (without moving onto how to improve performance). Feedback is not the same as generic praise (such as "that was really good") - it is specific.

Why give feedback?
In short, because it improves performance. It also increases the satisfaction and motivation of learners. Hattie's metan-analysis found feedback to be an effective educational intervention (equivalent to increase exam results by one to two grades). Marzano found that if the feedback was highly specific (see medals and mission model below) the effect size was equivalent to increasing performance by **more than two grades**.



Hattie describes three key feedback questions:
//Where// are they going? //How// are they going? <span style="font-family: Georgia,serif;">Where to next?

<span style="font-family: Georgia,serif;">Feedback, to be effective, contains accurate information about the quality of work; generalised praise or encouragement is //not// feedback

<span style="font-family: Verdana,Geneva,sans-serif;">Who should give feedback?
<span style="font-family: Georgia,serif;">Generally feedback is given by someone who can do something better than the person receiveing the feedback. <span style="font-family: Georgia,serif;">Effective feedback can come from peers, though (especially if comments are pooled).

<span style="font-family: Verdana,Geneva,sans-serif;">When and where to give feedback?
<span style="font-family: Georgia,serif;">There are two main rules about the timing: <span style="font-family: Georgia,serif;">1) Sooner better than later - memories will be fresher and chnages are more likley to occur as a result <span style="font-family: Georgia,serif;">2) When the learner is ready

<span style="font-family: Georgia,serif;">One-to-one feedback is best given in private. <span style="font-family: Georgia,serif;">Face to face, ono-to-one feedback is the most powerful way of giving feedback. Because of this it has advantages - it can bring about the greatest improvements - but also the greatest risks - "negative" feedback will be especially damaging if not delivered in a gentle and constructive way.

Extract from Phil Race's document
Face-to-face feedback can carry with it very high learning payoff for students. It can be memorable, and can help students to change attitudes and approaches. Face-to-face feedback (whether to individuals or groups) carries with it the additional explanation that comes through body language, facial expression, tone of voice, emphasis, and so on. Furthermore, in face-to-face feedback situations, you have immediate feedback on how your messages are getting across to students. You can tell a lot about how they are reacting to your feedback from their expressions, body language, and so on. Moreover, you can adjust what you say, and how you say it, to respond to your observations of what is happening. [|link to complete document]

<span style="font-family: Georgia,serif;">When a group is learning together, though, it may be useful - provided the group accept it - to provide feedback with the whole group present. This allows others to learn from the feedback given to one person (assuming they have the same goals and that they are likley to have similar shortcomings).

<span style="font-family: Verdana,Geneva,sans-serif;">How should feedback be given?
<span style="font-family: Georgia,serif;">Feedback, to be effective, has to follow the learner actually **doing** something, not just thinking or talking about it. <span style="font-family: Georgia,serif;">Although the usual mental model is activity then feedback, it can be useful, when circumstance permit, to provide the feedback during the activity. This is especially useful if it is followed by further activity by the learner. For example, if teaching BLS, rather than waiting until after 3 minutes before pointing out the learner is providing chest compressions at a rate that is too slow, tell them (+/- show them) the correct rate as soon as the fault is apparent, and then let them have another go with the correct rate. <span style="font-family: Georgia,serif;">To be effective feedback has to be accurate - it should only occur after close observation.

<span style="font-family: Georgia,serif;">One can consider two axes when given feedback: challenge and support. The most effectie feedback will tend to be high in both dimensions.

<span style="font-family: Georgia,serif;">When applied to the Johari Window model, feedback, when effective, increases the volume that is known to self //and// known to others, while reducing the volume known to others but unknown to self. It increases self-awareness in learners.

<span style="font-family: Georgia,serif;">If feedback is provided by someone with whom the learner is spending a lot of time, the person providing the feedback needs to make sure that they model the actions and behviours that they are expecting learners to do.

<span style="font-family: Georgia,serif;">Phil Race advises thinking about where the recipient of the feedback lies on the concious/unconscious competence/incompetence model when providing feedback:

<span style="font-family: Verdana,Geneva,sans-serif;">Unconscious incompetence
<span style="font-family: Georgia,serif;">In this area feedback is really important - incorrect (potentially dangerous) behaviours will persist otherwise. <span style="font-family: Georgia,serif;">Beware, though, that because the problems are in the "unconscious" box (unknown to the learner) and comments about them may well come as a surprise.

<span style="font-family: Verdana,Geneva,sans-serif;">Conscious incompetence
<span style="font-family: Georgia,serif;">This is often where feedback is focussed (especially if using Pendleton rules, and starting with learner perspective). The aim here is to help the learner generate ways of improving performance.

<span style="font-family: Verdana,Geneva,sans-serif;">Conscious competence
<span style="font-family: Georgia,serif;">The challlenge here is to avoid bland praise. <span style="font-family: Georgia,serif;">A good approach can be to get the learner to think about //why// what they did was effective, about why it was better than alternatives, and why it was timed well (i.e. right decision made at the right time).

<span style="font-family: Verdana,Geneva,sans-serif;">Unconscious competence
<span style="font-family: Georgia,serif;">Again, because this is in the "unconscious" are, the comments may come as a surprise but this time they will be a good surprise. <span style="font-family: Georgia,serif;">One approach to help the recipient of the feedback become more conscious of what they have done is to ask what they would view as the key things they did that they would want someone trying to acquire that skill to take notice of.

<span style="font-family: Verdana,Geneva,sans-serif;">How to receive feedback
<span style="font-family: Verdana,Geneva,sans-serif;"> <span style="font-family: Georgia,serif;">[|receiving feedback]

<span style="font-family: Verdana,Geneva,sans-serif;">Links
<span style="background-color: transparent; color: #000000; font-family: Georgia,serif; font-size: 16px; text-align: start; text-decoration: none; vertical-align: baseline;"> __<span style="background-color: transparent; color: #0000ff; font-size: 16px; text-align: start; vertical-align: baseline;">Giving feedback __ <span style="background-color: transparent; color: #000000; font-family: Georgia,serif; font-size: 16px; text-align: start; text-decoration: none; vertical-align: baseline;"> __<span style="background-color: transparent; color: #0000ff; font-size: 16px; text-align: start; vertical-align: baseline;">[|Feedback] __ <span style="background-color: transparent; color: #000000; font-family: Georgia,serif; font-size: 16px; text-align: start; text-decoration: none; vertical-align: baseline;">__<span style="background-color: transparent; color: #0000ff; font-size: 16px; text-align: start; vertical-align: baseline;">[|"Medals and mission] __" model for feedback <span style="font-family: Georgia,serif;">[|Giving and receiving feedback] <span style="font-family: Georgia,serif;">[|Giving feedback constructively] - standard format <span style="font-family: Georgia,serif;">[|Feedback] <span style="font-family: Georgia,serif;">[|Article]on feedback by Phil Race - includes the ripple model <span style="font-family: Georgia,serif;">[|Presentation] on feedback <span style="font-family: Georgia,serif;">[|Feedback skills]

<span style="font-family: Georgia,serif;">BEME[| review] of the effect of feedback on physician performance <span style="font-family: Georgia,serif;">(this relates to what would be termed in the UK as non-training grade physicians, rather than those in training posts)