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The program will start promptly at 12:00 PM

The program will start promptly at 12:00 PM. For technical assistance please contact Tech Support at 404-969-0387 or email support@healthtecdl.org. Faculty Development: Part 2 Preceptor Principles of Evaluating Learners and Giving Feedback. Augusta, GA December 11, 2008.

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The program will start promptly at 12:00 PM

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  1. The program will start promptly at 12:00 PM For technical assistance please contact Tech Support at 404-969-0387 or email support@healthtecdl.org

  2. Faculty Development: Part 2 Preceptor Principles of EvaluatingLearners and Giving Feedback Augusta, GA December 11, 2008 T. Andrew Albritton, MD Christopher White, MD Medical College of Georgia For technical assistance please contact Tech Support at 404-969-0387 or email support@healthtecdl.org

  3. Objectives • At the end of this part of the presentation, faculty will know: • the difference between formative and summative evaluation • the goals of evaluation • the RIME approach to evaluation If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  4. Objectives At the end of this part of the presentation, faculty will know: the stages of the learning of a new skill the characteristics of effective feedback how to give positive and negative feedback effectively the importance of observation in providing effective feedback If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  5. Stages of Learning a New Skill Unconscious Incompetence Conscious Incompetence Conscious Competence Unconscious Competence Howell WC. Human Performance and Productivity. Vol 2: Information Processing and Decision Making. Hillsdale, NJ: Erlbaum; 1982. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  6. Physicians Are Unconsciously Competent in Many Skills History-Taking Verbal Non-verbal Organization Physical Examination Technical Skills Reading X-Rays Interpreting most lab studies Surgical scrub Knot tying If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  7. It’s hard to teach someone a skill that you do automatically! If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  8. Therefore, physicians who teach medical students have to think differently, going beyond unconscious competence to a higher stage of competence If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  9. Stages of Learning a New Skill Reflective Competence Although “second nature, the practitioner can also articulate the fine details of the skill to others. Having fully understood all necessary steps and components of the skill to be learned and the manner how they are dynamically integrated . . . he is thereby able to teach the skill to others in a manner that is effective and expedient.” http://www.cognitivedesignsolutions.com/Instruction/TestingEvaluation.htm If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  10. Learning a New Skill: A Practical Example Non-driver: Beginner: Just passed driving test: Driver who gets to work without remembering the drive Consciously safe driver Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence Reflective competence If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  11. Evaluation Formative: Provide observations to help the learner assess strengths and learning needs to improve future performance. Summative: Assessing a learner’s performance using specific criteria to determine competency. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  12. Goals of Evaluation Clear and articulate description of performance. More objective evaluation of core competencies. Consistent evaluation of core competencies. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  13. Preceptor’s Responsibilities Treat the patient Diagnose the learner Teach the learner If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  14. Diagnosing the Learner • It’s easy: Ask 3 simple questions! • WHAT do you think is going on? • WHY do you think so? • WHAT do you want to do? If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  15. RIME* Approach to Evaluation Reporter Interpreter Manager/Educator *Based on the work of Louis N. Pangaro, MD If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  16. Reporter Accurately gathers information. Basic skills to perform a history and physical examination. Distinguishes normal from abnormal. Reports information without attempting integration or synthesize. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  17. Interpreter Demonstrates the integration and synthesis of information reported. Prioritizes clinical problems at a basic level. Develops a more patient-oriented assessment including a differential diagnosis. Actively participates in patient care. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  18. Manager Reports, interprets, and applies information to the patient. Makes diagnostic or management suggestions. Uses textbooks and the primary literature to better understand the patient. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  19. Educator Goes beyond the basics of self-directed learning. Critical appraisal skills. Demonstrates insight and explores important questions in more depth. Participates in the education of others. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  20. RIME Reporter:Passing but requires additional work to address deficiencies. “C” Student. Interpreter:Meeting Expectations. “B” Student. Manager/Educator: Exceeding Expectations. “A” Student. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  21. Giving Feedback: The Most Important Skill Needed to be an Effective Teacher If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  22. Feedback If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  23. What is Feedback? Feedback occurs when a learner is offered insight into what he or she actually did as well as the consequences of his or her actions. This insight . . . . Highlights the dissonance between the intended result and the actual result, thereby providing impetus for change. Ende, JAMA 1983; 250:777-781. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  24. Overview Feedback can be either: Positive: reinforcing what was done right Constructive: correcting mistakes or misconceptions Feedback goals: Ensuring the learner improves While keeping his/her self-respect intact If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  25. Important Elements of Feedback Rapport Clear expectations Appropriate location Timely and regular If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  26. Effective Feedback Descriptive and nonjudgmental Based on direct observations Focused on areas that can be changed Limited to what the learner can use The learner understands the feedback and knows the next step If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  27. Feedback ≠ Evaluation Feedback Presents information enabling the student to remain on course to reach a given goal. Evaluation Presents a judgment about how well the student met a given goal If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  28. Feedback ≠ Evaluation Feedback Presents information enabling the student to remain on course to reach a given goal. Evaluation Presents a judgment about how well the student met a given goal • Formative (coaching) • Summative (a grade) If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  29. Feedback ≠ Evaluation Feedback Presents information enabling the student to remain on course to reach a given goal. Evaluation Presents a judgment about how well the student met a given goal • Summative (a grade) • Formative (coaching) • Occurs after the fact • During or after the fact If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  30. Key Principle for Providing Feedback . . . .

  31. Key Principle for Providing Feedback . . . . You only see what you look for . . . . If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  32. Key Principle for Providing Feedback . . . . You only look for what you know . . . . You only see what you look for . . . . If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  33. Feedback: What Should Teachers Look For? Attitudes: Verbal & Non-verbal Punctuality Skills: Presentations Written Notes History & Physical Exam Knowledge: Differential diagnosis Therapy Management Observable Behaviors & Skills If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  34. Why Is It So Hard To Give Feedback? Failure to obtain data (observations) If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  35. Why Is It So Hard To Give Feedback? Failure to obtain data (observations) “Observations are the currency of feedback, and without them the process becomes ‘feedback’ in name only” Ende, JAMA 1983; 250:777-781. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  36. It’s hard to teach someone a skill that you do automatically! If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  37. Why Is It So Hard To Give Feedback? We readily recognize strong learners and weak learners by looking at how they perform common clinical tasks (Hx, PE, oral presentations, etc) “Unconscious Competence” We have difficulty “deconstructing” the individual components of the task in order to identify areas for feedback . . . . If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  38. Examples of Effective Feedback Dr. Dee Meaning Dr. Anne Spire Ende, JAMA 1983; 250:777-781. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  39. Examples of Effective Feedback Dr. Dee Meaning Dr. Anne Spire “Your differential diagnosis for this patient is inadequate” Ende, JAMA 1983; 250:777-781.

  40. Examples of Effective Feedback Dr. Dee Meaning Dr. Anne Spire “Your differential diagnosis for this patient is inadequate” “The differential diagnosis did not include the possibility of TB” Ende, JAMA 1983; 250:777-781.

  41. Examples of Effective Feedback Dr. Dee Meaning Dr. Anne Spire “Your differential diagnosis for this patient is inadequate” “The differential diagnosis did not include the possibility of TB” “You looked uncomfortable talking about your patient’s cancer” Ende, JAMA 1983; 250:777-781.

  42. Examples of Effective Feedback Dr. Dee Meaning Dr. Anne Spire “Your differential diagnosis for this patient is inadequate” “The differential diagnosis did not include the possibility of TB” “While observing you, I began to feel that you were not comfortable talking about your patient’s cancer” “You looked uncomfortable talking about your patient’s cancer” Ende, JAMA 1983; 250:777-781.

  43. Giving Positive Feedback If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  44. Giving Positive Feedback Not general praise . . . . “You did a good job with that patient.” “You are doing fine.” If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  45. Giving Positive Feedback Not general praise . . . . “You did a good job with that patient.” “You are doing fine.” Inform the student about a specific behavior or action that was done well “You gave a very good description of your patient’s general appearance. Successful clinicians are good observers, and you have demonstrated that you are developing good observation skills as you evaluate patients. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  46. Giving Constructive Feedback Label the feedback Identify a specific behavior or action that was done wrong Tell the student how to avoid or correct the error in the future Make sure the leaner understands the feedback If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  47. Helpful Hints Ask for the learner’s thoughts about his/her performance first Avoid vague, harsh, or judgmental statements Feedback sandwich Tell what was done well Tell what was done wrong Discuss to do next time If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  48. Why Is It So Hard To Give Feedback? Failure to obtain data (observations) “Observations are the currency of feedback, and without them the process becomes ‘feedback’ in name only” Ende, JAMA 1983; 250:777-781. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  49. Take Home Messages • Assessment drives learning • Objective evaluation of core competencies helps the student become a better physician • Using the “3 W’s” helps the student in developing their interpretation and management skills • Working hard does not necessary mean an “A” performance If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

  50. Questions? Please Type your questions in the chat box provided on the screen. If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org

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