Providing Feedback to students on placement

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Types of feedback

Providing regular, effective feedback to your student is one of your most important roles as a student supervisor. Opportunities for feedback during placement include:

• 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 'summative' feedback associated with assessment.  

Preparing for a feedback session

Before you provide feedback, it is important to consider your expectations and share these with the student.  Preparing for a feedback session should involve:

Giving quality feedback

Quality feedback needs to be:

• Focused on patient centred care
• Timely and in an appropriate setting
• Objective, specific, constructive, and balanced.

This next video explores these elements in more detail:

A feedback session that incorporates the components identified in the video above, should be a dialogue between two people:

• Encourage two-way discussion through use of active listening and elements of advanced questioning. 
• Remember to be aware of you and your student’s body language and moderate how fast you’re talk during the session. 
• Use pauses to allow the student to consider the feedback and seek clarification if they require.
• Provide students with an opportunitiy 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 if required.
• Monitor for understanding.  Allow time and provide opportunity for the student to react, reflect and respond. This might be by including statements or questions like: “Let’s decide together on the action plan required to address the feedback".  

Asking the student for feedback on the supervision provided can also be good role modelling. This can assist to 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.  It can also reduce a perceived power gap if the supervisor reveals their own vulnerabilities and acknowledging that learning is ongoing.

In the figure below, Weallans and colleagues (2021) explore the sequential process of providing feedback:

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

Feedback models

The use of feedback models can assist student supervisors prepare and plan their feedback session.  Hardavella (2017) outlined various 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 provide positive feedback on its own when the opportunity exists.
• Chronological fashion:  If it is only a small amount of feedback, then this method may be useful. It involves reflecting on the positives and opportunities at each stage/interval of the assessment.
• 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. 

  eLearning and resources for providing feedback

• FACT SHEET - Framing Feedback
• Supporting Health students in the workforce Tasmanian Clinical Supervision Learning Package for Health Professionals has been developed to help guide and support clinical education and supervisor training activities in Tasmania. The 4^th module in the series of open access eLearning modules is on ‘Constructive 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
• Duffy, K., (03.04.2013). "Providing constructive feedback to students during mentoring". Nursing standard (0029-6570), 27 (31), p. 50.
• 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.
• Johnson CE, Keating JL, Molloy EK. Psychological safety in feedback: What does it look like and how can educators work with learners to foster it?. Med Educ. 2020;54:559-570. https://doi.org/10.1111/medu.14154
• Weallans J, Roberts C, Hamilton S, Parker S. Guidance for providing effective feedback in clinical supervision in postgraduate medical education: a systematic review. Postgrad Med J. 2021 Feb 9:postgradmedj-2020-139566. doi: 10.1136/postgradmedj-2020-139566. Epub ahead of print. PMID: 33563716.