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Special Feature: Preceptor Development - Providing Effective Feedback

18 May 2021 1:56 PM | Anonymous

By: James Unverferth, PharmD, BCPS; Pharmacist Clinical Specialist

SSM Health St. Mary’s Hospital – St. Louis

Background

Feedback and how to effectively provide feedback is a topic becoming ever more relevant as the years go on mostly due to the “millennial” generation filling the roles of students and residents. Supporting the portrayal of millennials on TV and social media, studies have shown that millennials desire frequent coaching and feedback.3

Feedback is important because it helps learners to identify areas of weakness in which they can build on foundational skills and knowledge. If done correctly feedback should help students to establish goals and evaluate performance so that over time they become sufficient enough to rely only on themselves for evaluation and motivation. Additionally, preceptor feedback is a topic that is frequently cited on accreditation surveys for residency programs. Accreditation standards specify that this feedback needs to be specific and criteria-based. To lend guidance on how preceptors can help learners achieve this goal, ASHP has developed a 3 part competency-based approach (Figure 1) to evaluate resident performance of a program’s educational goals and objectives, resident self-assessment of their performance, and of the program itself.1 This approach, while effective, is mostly tailored towards residency programs and may not be completely applicable to all learning situations, so I have developed a 6-part approach to establish a process of providing quality feedback to any learner. I hope this process helps you realize the importance of providing constructive feedback and its relationship to growth of a learner.


Six-part Approach for Providing Effective Feedback

Part 1: Establishing Expectations

The first step in my 6-part approach is to establish expectations. This stage of the process of providing quality feedback can begin even before a learner starts on rotation. Knowing past experiences of learners and what stage they are in in their studies or career can help shape expectations for the preceptor. For example — expectations for a rotation are going to be different for a resident on their last rotation compared to an APPE student on their first rotation, compared to an IPPE student on their first ever experiential rotation. Regardless, it is important to involve the learner in the process of establishing expectations. Before a learner starts a rotation have them develop SMART goals for the rotation.


Having students develop SMART goals will help preceptors when it comes time to evaluate the learner’s performance throughout the rotation AND it is a good exercise to refresh learner’s memory on how to set proper goals to achieve therapeutic outcomes for patients.2 A SMART goal is specific, measurable, achievable, realistic, and timely. In addition to having learner’s create their own goals, studies have shown that physically writing out goals improves the likelihood of achieving those goals.2 Once you have the learners create goals, it is important to meet with them to discuss and hold them accountable for creating quality SMART goals. Once these are documented, criteria needed to meet these goals can be established between the preceptor and the learner so that expectations are clear for both parties at the beginning of the rotation.

Part 2: Creating Learning Opportunities and Part 3: Observing Learning Experiences

Parts 2 and 3 of the six-part approach go hand-in-hand. Creating and observing learning opportunities is important because well-developed and well-defined learning activities provide preceptors with the means for directly measuring performance and progress toward fulfilling the learner’s goals. Additionally, this is where learners can apply feedback received by the preceptor after previous experiences. If a student is struggling to grasp a concept or has difficulty applying feedback, this is the opportunity that preceptors can practice the four roles of preceptor to enhance learning; by instructing, modeling, coaching, and facilitating.1


Part 4: Providing and Documenting Formative Feedback

During or directly after a learning opportunity it is important to take the time to provide feedback to students. It has been shown that as more time-elapses between learning experience and feedback, the value of the feedback drops, so it is best to provide frequent feedback sessions, even if the sessions are short. On top of feedback immediately after a learning experience, a common practice utilized by preceptors and often appreciated by learners is to schedule a time at least once a week to discuss progress and what things are working or not working. During and after observation and feedback sessions it is beneficial for the preceptor to write down notes on feedback provided to the learner so that it can be followed-up on or relayed to the learner at a later time. This is important because it may help you be more specific and evidence-based, providing more weight to your recommendations to the learner. Additionally, it has been shown that time is one of the major barriers of providing effective feedback to learners so by taking notes in the moment this can help save time on the back end when reflecting on learner’s performance.4

As mentioned earlier, the goal of feedback is to help learners identify areas of weakness in which they can build on foundational skills and knowledge. It is not meant to degrade, belittle, or embarrass a learner. With this in mind, feedback should be goal-related and actionable. It should be diverse, which means that it should not only be correctional, but should also be affirmative, observational, or even just clarifications. Lastly feedback should focus on the process and not the person. For example – “James you are a quiet person, speak louder next time” instead you can say “It can be hard to hear over skype phone calls, you may want to speak loud and into the microphone next time”. These are just some of the many principles behind providing quality feedback. A quick Google search of “how to provide quality feedback” will result in over a billion hits with links to articles on qualities of effective feedback, but the qualities discussed here are those that appeared most often and found to be worth sharing.

Now that some of the qualities of effective feedback have been defined, it is time to discuss appropriate methods for delivering feedback to the learner. The first method is called the sandwich method or can also be referred to as pro/con/pro method. This method starts with the preceptor stating something the student did well, then something the student can improve on, and finishing with another thing the student did well. This method leaves the student feeling encouraged instead of down in the dumps. Each comment, both positive and negative, should meet criteria for feedback discussed on the previous paragraph in order to be a “good sandwich”. Some “sandwiches” to avoid include; a “plain sandwich” that offers feedback but lacks any areas for improvement, a “finger sandwich” that offers feedback that is not very informative and is light on comments overall, an “open-faced sandwich” that starts off with just negative comments, and finally a “low-carb sandwich” that does not identify any strengths at all.6

The next method is the SII method or Strengths, Improvements, Insights method. This method is good to use informally or if no specific criteria are available. As the name implies it involves highlighting strengths of the learner observed during the experience, ways in which performance can improve, and finally insight which involves reviewing relevant new discoveries/understandings that occurred during the experience. It can be sometimes hard to provide insights, so here it may be best to come up with some teaching points that student can use moving forward.6

The last method to discuss is the Pendleton Method. Anecdotally, this is the most common method used among preceptors as it encourages the student to self-reflect about each learning experience and evaluate their own performance before hearing from the preceptor. Here it is important to facilitate a discussion while remaining positive, making sure to focus again on the process and not the person. In the end the preceptor and learner should agree on an action plan to move forward with.6

Table 1: Feedback Methods6

Sandwich Method The assessor provides positive comments first, followed by areas in need of improvement, and ends with another positive statement
SII Method • Strengths

o Highlight the positives in the performance

• Improvements

o Focus on ways in which the performance could improve

• Insights

o Identify new and significant discoveries/understandings that were gained concerning the performance area

Pendleton Method

• Student states what was good

• Evaluator states area of agreement and elaborates on good performance

• Student states what was poor and could have been improved

• Teacher states what could have been improved

• Action plan is agreed upon

After this formative feedback is provided, the expectation for the learner to apply it to future encounters. Again, if learners struggle to implement feedback this is where preceptors can implement the four roles described earlier to demonstrate ways in which the learner can improve. By repeating this process over and over throughout a rotation, the hope is that the learner’s performance will continuously grow so that they can reach the goals they set at the beginning of the rotation.

Part 5: Learner Self-Evaluation

At the end of the rotation when hopefully all the SMART goals set and, the learners should perform a self-evaluation. Here the learner should be encouraged to really spend the time reflecting on their performance to come up with things they have done well and things on which they can improve.

Part 6: Summative Evaluation with Preceptor

The summative evaluation should strengthen the message from the formative feedback sessions you have been providing throughout the rotation. Hopefully if you have been meeting with the student regularly to provide feedback after learning experience as was suggested earlier, this should be easy to come up with specific, evidence-based feedback. Several things to keep in mind while wrapping up rotation with the learner: go in with the right intentions. No matter how poorly the learner performed, this should not be a time to condemn/demoralize the student. It should also not be a time to make yourself seem powerful or superior. The purpose of the evaluation is to guide, support, and enhance the learner’s ability to become a successful pharmacist as well as self-evaluator and motivator. Additionally, a final evaluation should not be the first time a learner is hearing constructive feedback. It can be discouraging and unhelpful for a learner to hear that their performance was not up to par without ever getting the chance to remedy or improve. To that point, not every student on their final evaluation should be given an “A”. This can make it difficult to distinguish genuine superior performance and overall good work. So, don’t be afraid to be negative with your feedback as long as it is not the learner’s first time hearing the constructive feedback and it is delivered in a way with the learner’s best interest in mind.

To wrap up the six-part approach, here are some more tips that can be utilized to enhance both formative feedback and summative evaluation. Many of the things have been touched on before, but a few things not previously mentioned that should be kept in mind: environment – it is best to provide feedback in-person so that a discussion can be had between learner and preceptor. Ideally this should be private, especially if doing a summative evaluation. If on-the-fly feedback is necessary, make sure not to call out the learner but instead wait for a time to take the learner aside and provide instruction on how their performance can improve the next time. Another good tip: always focus on the future. Lastly, feedback is always better if it is individualized. It may be helpful to have a student send you strengths/weaknesses prior to rotation starting.5 This way you can relate feedback to those characteristics.

References

  1. Buck B, Wilkinson S, Phillips H. Preceptor Development: Providing Effective Feedback, Part 2. Hosp Pharm. 2014; 49 (6): 521-529.
  2. Lawlor KB, Hornyak MJ. SMART Goals: How the Application of SMART Goals can Contributed to Achievement of Student Learning Outcomes. Developments in Business Simulation and Experiential Learning. 2012; 39: 259-267.
  3. Meister J, Willyerd K. Mentoring Millenials. Harvard Business Review, 88(5).
  4. Skrabel MZ, Kaheleh AA, NEmire RE, et al. Preceptors’ Perspectives on benefits of precepting student pharmacists to students, preceptors, and the profession. J Am Pharm Assoc. 2011; 75(1): Article 10.
  5. Wilkinson S, Couldry R, Phillips H, Buck B. Preceptor development: Providing feedback to pharmacy residents: Part 1. Hosp Pharm. 2013;48(1):26–32.
  6. Sarkany D, Deitte L. Providing Feedback: Practical Skills and Strategies. Acad Radiol. 2017l 24 (6): 740-746.

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