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Types of feedback

Providing regular, effective feedback to your student is one of your most important roles as a clinical supervisor. Numerous opportunities for giving feedback should occur during a clinical placement including:

  • Informal feedback: part of the normal day-to-day interaction. 
  • ‘Formative’ feedback i.e. feedback that is specifically designed to reflect on the student’s current performance, relative to learning objectives, with guidance on strategies for improvement, THAT IS NOT ASSESSED.
  • Formal feedback associated with assessment

 

Consequences of a Lack of Clear Feedback

Cohan, 2005 (as quoted in Health Education and Training Institute, 2011) lists the following consequences of a lack of clear feedback:

  • Clinical care is not as good as it could be.
  • Anxieties and inadequacies are not addressed.
  • When weaknesses are exposed later in their career, the staff member has difficulty accepting criticism because of previous ‘good reports’.
  • Others are blamed when the staff member is unsuccessful.
  • Learning is inhibited, career progression is delayed.
  • Staff are not given the ability to develop to their full potential.

Therefore, even though at times it can be challenging giving negative feedback, failure to do so can have a significant effect on the student’s future development and career.

On this page you will find:

  • Tips for giving effective feedback.
  • Feedback models.
  • Barriers to effective feedback.
  • Video scenarios showing effective and ineffective feedback delivery.
  • eLearning and resources for providing feedback.
  • Reflection activity.

Giving Effective Feedback

Giving effective feedback is a skill to be learnt. Feedback that is inconsistent in amount, type and timing can be detrimental for a student’s progress. In short, feedback should be:

  • Timely: as close as possible to the event but with care to pick a good moment (not when you or the student is exhausted, distracted or upset) that allows enough time so that the feedback session is not rushed.
  • Constructive: Talk in terms of what can be improved. 
  • In an appropriate setting:
  • Prepared:
    • Plan what you want to talk about and how you will deliver this. Identify and emphasise the key points, being mindful to limit the number of key points in each feedback session.
    • Review and use any reference or student placement documents to help with your word selection, for example if the feedback is relating to a specific competency.  Ensure you adopt clear and precise use of words or terms.
    • Try to make objective rather than subjective comments, by removing the ‘I’ and replacing it with ‘there’ or ‘it’, e.g. ‘It was apparent that there was…’.
    • Don’t talk too fast. Use pauses.
    • Be aware of your and your student’s body language during the session.
    • Be sure to choose an appropriate time and space to provide feedback to students.  Positive feedback can be effective when given in the presence of peers or patients. Negative feedback (constructive criticism) should be given in a private and undisturbed setting.
    • Before you provide feedback, it is important to consider your expectations and share these with the student.  If you don’t share your expectations, there is little framework from which you can base your evaluations and develop and deliver feedback to the student.
    • Plan the feedback session so both you (as supervisor) and the student have an opportunity to prepare.
  • Specific: Vague or generalised praise or criticism is difficult to act upon. Be specific, through the use of examples.
  • Balanced:  recognise positive and negative events to avoid the student becoming disheartened.

A feedback session should be a dialogue between two people. Encourage two-way discussion through use of active listening and elements of advanced questioning.  Students should be given the chance to comment on the fairness of feedback and to provide explanations for their performance.

It is important to remember that students may not be used to receiving feedback or their previous experience of feedback may have been poor. Be prepared for an emotional response from the student, and encourage them to take a break at any time

Monitor for understanding.  Allow time for the student to react, reflect and respond. Decide together on the action plan required to address the feedback.  This might include what documentation is required from the feedback session, the role of the university, and identifying a follow up plan.

It can also be good modelling if the supervisor asks the student for feedback too!  This can help promote a work culture where ‘feedback’ is the norm, it aids in the development of the student-supervisor relationships, and it might identify ways in which to improve your supervisory skills.

Please also read the Advanced Questioning section contained within the Communication section of this website. 

Feedback models

The use of feedback models can assist clinical supervisors prepare and plan their feedback session.  Hardavella (2017) outlined these feedback models:

  • The feedback sandwich:  The feedback sandwich starts and concludes with positive feedback, and what can be considered as the more critical or constructive feedback is “sandwiched” between the two positive aspects.   To avoid students becoming familiar with this model and waiting for the ‘but’, it is important to give positive feedback on its own when the opportunity exists.
  • Chronological fashion:  if it is only a short amount of feedback, then this method of reflecting on the positives and opportunities at each stage/interval of the assessment can be useful.
  • Pendleton model:  this conversation based model is learner centred and allows the student to initiate the feedback session by articulating what is being assessed and what they did well.  This can then be verified by the facilitator and creates a safe environment first by identifying positives.  This can reduce the risk of students becoming defensive and can allow for an action plan or goals to be developed.  

Barriers to effective feedback

  • Untimely and unexpected feedback that is not specific and/or identify opportunities for improvement can limit the likelihood of the feedback being effective.
  • Student supervisor relationship – trust and respect are required in this relationship to facilitate a safe environment for effective feedback. 
  • Lack of supervisor confidence in the delivery of feedback and fear of upsetting the student can affect the student supervisor relationship and be a barrier to the delivery of effective feedback
  • Language and cultural differences that affect the way feedback is given and received can also be a barrier to effective feedback if not managed appropriately.

Video Scenarios:  Ineffective and Effective Feedback

These four scenarios explore the impact of communication skills on feedback to a student on placement. In scenario 1 the clinical educator tells the student his view of the session. The feedback is clear and specific but not constructive. The clinical educator does not acknowledge what the student has done well. He doesn't use positive body language and fails to interpret the student's body language while giving feedback. 

 

 

 

In scenario 2 the clinical educator's message is not clear and the student is left wondering what was the point of the feedback.

 

 

In scenario 3 the clinical educator is positive but time poor and does not dedicate time to provide feedback to the student.

 

 

In the final scenario the clinical educator has excellent communication skills and the feedback session goes well. The process is a facilitated discussion where the student is engaged and reflects on her performance. 

 

 

eLearning and resources for providing feedback


References:

  • ACT Government, (nd) ACTPS Performance Framework:  The Art of Feedback:  Giving, seeking and receiving feedback.  Accessed November 2020 from https://www.cmtedd.act.gov.au/__data/assets/pdf_file/0003/463728/art_feedback.pdf
  • Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. B. (2017). How to give and receive 
feedback effectively. Breathe (Sheffield, England)13(4), 327–333. https://doi.org/10.1183/20734735.009917
  • Health Education and Training Institute (2011). The superguide: A handbook for supervising allied health professionals. Sydney: HETI. Retrieved from:  https://www.heti.nsw.gov.au/education-and-training/our-focus-areas/allied-health/clinical-supervision
  • Health Education and Training Institute. The Learning Guide a handbook for allied health professionals facilitating learning in the workplace. Sydney: HETI, 2012.
  • Health Workforce Australia (2013). Enabling Clinical Supervision Skills. Griffith University, Gold Coast
  • Duffy, K., (03.04.2013). "Providing constructive feedback to students during mentoring". Nursing standard (0029-6570), 27 (31), p. 50.

Topics

Reflection Activity: Giving Effective Feedback

Giving effective feedback is a skill to be learnt.
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