October 4, 2012

Taking the Fear Out of Feedback

by Connie Yoon, Pharm.D., Assistant Professor, University of Maryland School of Pharmacy

During my two years of residency training, I knew providing feedback to my preceptors regarding the rotation and their teaching behaviors was expected.  Yet for some rotations, this moment was filled with fear.  Fear that the receiver would misunderstand my intentions or that this may harm my relationship with this person.  Fear that what I said would be misused or turned against me.  Despite this fear, I provide them with honest feedback.  Why did I take the risk and perhaps face retribution? Because feedback is necessary for professional development and learning.  I consider feedback as an opportunity for quality improvement, not a reason for retaliation.  I should also clarify that while fear may be a roadblock to giving feedback, it is also a roadblock for those receiving feedback, particularly when the feedback is negative.1  Feedback is a two way street.  In a field where feedback is critical to facilitating education and patient care, it is important to review methods for delivering and receiving constructive feedback.

To begin, we must define feedback in the context of teaching and learning.  Feedback involves “a process to collect information to determine whether or not successful teaching and learning has occurred.”2  Feedback is “a commitment between teachers and students for academic and professional development.”3   It is an important tool used by successful teachers to make adjustments to the teaching process by identifying areas that are successful and those that require improvement.

Feedback is strongly associated with students’ perceptions of the quality of education.4  Therefore, as educators, we must consistently give and request feedback from students.  However, the unfortunately reality is that students are infrequently requested to provide feedback regarding the teacher’s performance (and typically only at the end of a course!).  Conversely, teachers do not provide feedback to students as often as they'd like.5  Moreover, teachers tend to have an inflated view of their feedback skills.  This was evident in a study published in 2008 by Sonthisombat.5  This study surveyed Pharm.D. students and preceptors to compare the perceptions of preceptors to that of students in regard to the preceptor’s teaching behaviors.  Survey items included rating the teacher’s frequency in giving positive feedback for good work, inviting comments or criticisms of the preceptor, discussing student strengths and limitations, and evaluating and advising students of their progress.  On nine of the 47 items, preceptors’ ratings were significantly higher than that of student ratings.  The majority of the preceptors perceived themselves as “well done and adequate” in terms of providing feedback to students, providing positive feedback, and responding positively to student’s comments and suggestions.  A significantly lower percentage of students rated their preceptors as well done and adequate in these areas, revealing a disparity between preceptors’ and students’ perceptions.  This study identified several areas for preceptor development and providing feedback was clearly a prime component. As educators, if we are committed to our students and the quality education of their education, giving constructive feedback is one thing we must learn to do well.

In order to fulfill this commitment, we must create an environment that encourages giving and receiving feedback.  There are several characteristics of constructive feedback.1-3  Feedback should be:
  • Relevant.  Address the teaching and learning performance objectives identified for the learning activity.
  • Objective.  Base feedback on facts or observations not on feelings. Keep comments impersonal as much as possible.
  • Individualized.  The goal of the feedback is to meet the needs of the student or teacher and enable the receiver to maximize their potential.
  • Helpful or informative. Provide suggestions for improvement.
  • Respectful.  Respect the student and/or teacher’s integrity and needs.
  • Confidential.  Do not involve intermediaries unless absolutely necessary.  Only the student and teacher should be involved in the feedback session.
  • Encouraging.  The student and teacher should be motivated by a desire to improve their learning/teaching methods.  This will can help to reduce the hostile emotions commonly associated with feedback that is negative.
In general, feedback is better received when given in a timely manner so that recipients have a opportunity to improve.  More frequent feedback makes each encounter less emotional and feedback becomes a common, routine part of the learning process.  Learning expectations for the activity should be articulated early to reduce ambiguities in performance objectives and minimize surprises during the evaluation.  Negative feedback should be balanced with motivational statements and positive feedback.  In order to maximize the potential use of feedback as a learning tool, both the deliverer and receiver of feedback should be receptive.  Solicit feedback and express appreciation when receiving it to model an accepting behavior.1  Most importantly, create an atmosphere of trust and respect when giving and receiving feedback.

Constructive feedback, given or received, plays a critical role in teaching and learning.  We should not allow fear to prevent us from employing feedback in our daily activities.  Providing feedback in a structured, constructive manner can help minimize fear and maximize its utility as an educational tool.

1.    Hunter TS. Giving and receiving constructive feedback in pharmacy practice. Drug Topics [Internet]. 2009 Jun 1 [cited 2012 Aug 30].
4.    Torres DM, Sebastian JL and Simpson DE. Learning activities and high-quality teaching: perceptions of third-year IM clerkship students. Acad Med 2003;78:812-814.
5.    Sonthisombat P. Pharmacy student and preceptors perceptions of preceptor teaching behaviors.  Am J Pharm Educ 2008;72(5):1-7

1 comment:

lcsera said...

Thanks, Connie! I found particularly interestesting the phrase "...teachers tend to have an inflated view of their feedback skills." As a learner I know I valued preceptors who would give feedback frequently. I wonder if preceptors would benefit from a "midpoint evaulation" such as the students get...but would fear hold students back from giving constructive feedback? How do we address that fear so that we can also improve?