Tuesday, October 9, 2012
Purposeful Observation & Feedback
Two of the most important gifts you can give your learners are... a) your attention and b) your feedback. As we know from reading the Merriam text, observed experience is vital to assessing learning. Some might say that anything else is just a proxy for understanding what the learner has truly learned. Observation, however needs to be purposeful. We need to know first what behaviors are expected then find "High Yield" situations likely to produce those behaviors if learned. The other side of the coin is useful feedback; that is, feedback that would be useful in improving or sustaining good practice. This session provided the opportunity to think about and practice observation and feedback... any comments?
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17 comments:
Particularly like the Ask-Tell-Ask method because it gives the learner the opportunity to self-assess and may even help reduce any bias on the part of the instructor.
We started off the session today by generating a class list of remembered impressions from a recent interaction with a learner. The generated list focused mostly on global feelings or behavioral qualities. Although not the focus of the feedback, I think these are important to be aware of- they represent our biases or behaviors the student may be demonstrating that may potentially hinder or at times facilitate the learning experience. The situation which prompted my adding the word "preoccupied" to the list involved a senior medical student who came to participate in a mock residency interview. He seemed distratcted by something and when I finally asked, he conveyed his upset over accidentally not applying to a residency program he was particularly interested in and whose deadline for apllication had now just passed. Addressing the preoccupation first, I believe, facilitated the actual targeted activity and engendered a better performance. I think observation, not only during the observed experience but even prior to it is important. Perhaps this falls under the heading of paying attentioon during the warmup piece. It can help us not only guage where the learner is but it also allows us to guage where we might be as well- how do we feel about what the student is telling us, what biases or emotions are surfacing, even before the formal observation tied to the exercise has started. The narrative feedback we subsequently generate can be easily colored by these things. I find it a challenge to sometimes dissociate feelings and emotions associated with prior interactions with a student in subsequent experiences with the student. Perhaps those who are better able to reflect-in-action have a better chance of modulating those.
I read with great interest the paper supplied to us by Dr. Taylor on Self-assessment,Self-direction,and theSelf regulating Professiona by Glenn Regehr and Kevin Eva. It gave me a new perspective on the incentives that professionals have to learn or to avoid learning. I belive that these authors have hit the nail right on the head. My own experiences with poor performers has been that they fail to identify gaps in their knowledge, and even when offered advice about the gaps, many continue to perform in a mediocre fashion. Those who overcome their deficiencies are those who acknowledge their presence and invest the time and effort to remedy. I realize the necessity for recertification as many of us would ignore or avoid dealing with gaps in essential knowledge if it is not "fun" to learn. I also am reminded how difficult it is to make learning any subject "fun" to all people in the audience. I would recommend this paper as essential reading to all professionals.
Unfortunately, I was unable to make this session, but I have attended other sessions on observation/evaluation/feedback, and enjoyed, as did Elias, the papers given to us by Dr. Taylor. I believe the use of observation and targeted feedback greatly enhances learning and "speeds" the learning process by avoiding random trial and error by the learner. I had the opportunity to help initiate the use of ACGME-type accreditation in Singapore within the otolaryngology community just over one year ago. This is a country that had used the British system of training up until our encounter. I learned much about the previous system and the one that I was teaching, but I gained particular insight into the differences. The British system is based on long periods of observation and then a distant evaluation and minimal feedback, except as to pass/fail. The ACGME (US) system was based primarily on the concepts of setting goal and objectives, and then assessing/observing with respect to those goals and objectives, and then providing both immediate and more formal long-term feedback. This latter system greatly increased the efficiency of the residents' experiential learning, and therefore produced a better resident in less time. This obvious outcome had never become more apparent to me, and I enjoyed the insights of the Singapore doctors as well, who had trained in the previous system and were now preparing to train a new generation of learners in the ACGME system. It really cemented for me the benefits of structured feedback to the learner, and to some extent, to the teacher as well.
The ask-tell-ask model that was discussed in class this week is a tool that is applicable in many settings. Although this is very new and I have not formally discussed this with my group to incorporate it into our routine, this past week I tried to employ some of the basic steps while conducting a 90-day review with one employee. I started out by asking the new employee to do a self-assessment on her responsibilities, what she feels she is doing well and where she has had challenges. I was a little surprised on her response. As we discussed in class, she did bring up items I may not have addressed had I not asked for her observations first. We spoke about the items she mentioned and I then acknowledged her concerns and stated my observations and an item for improvement. I did ask her for her understanding of the issue and she gave me suggestions how to make some changes and improve. We also discussed goals and items she would like to learn and focus and the steps needed to achieve these goals. As the details of these steps are new, becoming proficient using them will take some effort on my part and time to plan out and incorporate them into a regular process. However, I do think this process will be useful in an effort to reduce my biases and hear more from the employee’s perspective in regards to goal achievement in the workplace and effectively observe and provide useful feedback to each employee.
David Wheeler
The notion of observing behavior and then commenting on it in a constructive way is rather difficult to perform in a way that both articulates the experience of the instructor/observer and is consequential to the understanding of the adult learner. It is critically important to maintain fidelity to the experience in the observation of an adult professional learner. It is probably obvious to many people that the observer brings with them several biases. In this session we discussed a few of them. The halo effect is probably one of the more common yet insidious forms of evaluation bias and it seems to be an extension of an egocentric worldview on the part of the observer. Leniency error is a residue of the, “I am special”, mantra of the education cartel in the 80s and 90s. Instructors/students may believe that there is an entitlement to a superior valuation simply because one has shown up. There seems to be a bias to err on the side of the students self-esteem rather than an authentic interests in increasing their knowledge base or skill sets. The other side of the coin is severity error this I believe is another form of seeing the student through an egocentric lens, wherein the observer feels that by being more severe they are enhancing the learning experience and affirming their own bizarre sense of self superiority. The same as me error is another extension of ego. The observer rates the students higher because they mimic the instructor. Again, the veil of ego can be blinding. The different for me error is probably based in fear and insecurity where the observer rates of student lower simply because they are different or not the same as the observer. An incredibly shallow and unthinking form of bias. The 1st impression error probably spills over into every aspect of our lives. One must be aware of and guard against these forms of bias. It is imperative that we examine in a very authentic and just way the actions and observable phenomena of those we teach. They deserve an observation that will help them critically reflect upon and improve upon their knowledge, skill and clinical expertise. It is up to the instructor to examine them selves and in a very detached way observe how they are observing.
Although I think the ask-tell-ask method is very usefull and effective in many cases, I think some individuals, especially those who are inexperienced such as medical students or residents, might be so overwhelmed with everything they are trying to accomplish that they might not even know how well their performance went. Sometimes we get so caught up in the moment that we barely remember our interaction with whomever else is involved in the situation, such as the patient in our exercise. I think it would be appropriate ask them how they think their performance was, but if they do not give a great response, I would not simply assume they think they did well. Situations in which we are going to be formally evaluated are stressful, and interacting with patients is stressful as well, especially if we are not yet all that comfortable with this skill. I think it is then appropriate to give them suggestions on what to do better, or perhaps what you might do, instead of telling them point blank what they may have done wrong, which is something my partner and I discussed in detail last session. I also think it is important to accentuate their positive behaviors so they continue to build on their skill, as well as making sure they are not given all negative feedback. I look forward to having students or trainees one day so I can utilize everything I am learning in both class and the workshops.
Anesthesia is full of direct observation opportunities. Every day we work with trainees in the operating room and the ICU observing their patient care, medical knowledge, professionalism and interpersonal skills and communication. The difficulty comes in the fact that we may only work with a trainee once during a given 4 week rotation and can give feed back on what to improve on but never know if it has any effect.
I think the ask tell ask model is a good tool for working with learners. I agree with some of Rachel's comments that depending on where the student is at in their education or how adept they are at self evaluation it could be awkward at first for them to be able to give you feedback. I think keeping the ask fairly general and seeing how certain encounters made them feel would help. Plus using the ask tell ask model consistently would help the student reflect and further conversations should go much easier. I would mention that for patients a tell ask tell model could be employed but I do not know if one exists.
The Ask-Tell-Ask method is important when trying to determine where a learner is or where they might be having difficulty understanding. Within our unit we have weekly meetings with new orients, I tend to speak with the new orients daily to see where their comfort is with their new job responsibilities. Audits and sit down, overview type conversations occur as well. I think the Ask-Tell-Ask method is beneficial because it is quick and allows you to gage where the learner is. Like Brian said, it can become difficult when he doesn't see his Anesthesia Residents on a continual basis, it can be difficult for me in a different retrospect as I help manage over 90 employees and might have 5-6 orients at a time.
Miguel A. Morillo...
It seems to be unanimous that feedback is an integral part of any successful teacher - learner interaction. I'd venture to say that feedback goes beyond education. We all want feedback( even brief feedback) from almost any human and even non human interaction (from our pets, nature, machines, etc). Feedback is the answer to our questions, the closure to discourse, the consequence of our actions or in-actions. It sometimes instills confidence to receive feedback, or happiness if it is positive to us and it is sought after. Feedback comes in may forms, the range can go from simple body language, gestures or short verbal expressions, to written and formal. After all this said, why is it so difficult to give feedback? The answers abound. Among the many reasons we can find is that to give feedback we must have engaged in an encounter to which we are actually attentive. There's no meaningful feedback if we have not payed any attention to the interaction by proper observation of such interaction. Observation defined as: consists of receiving knowledge of the outside world through our senses, is the limiting first step in giving meaningful feedback. We should start by training ourselves to become better observers, in order to help our students with good feedback.
I think that educational curricula should have embedded protected time for feedback. It is not honest to state that we are teaching with the expectation or necessity to evaluate the student at a latter time, without giving meaningful, significant and timely feedback.
Felecia Roberson,
I found the Ask-Tell model to be very beneficial in helping the trainer and learner communicate in a positive manner. The ask-tell model gives the trainer the opportunity to guage where the learner is at in the learning process; it enables the trainer to hone in on what reinforcement the trainee may need. This model also allows the trainee to reflect on what they have learned and what they feel they are struggling with without being made to feel inadequate. By allowing the trainee to "ask" so that we may "tell" allows the trainee to take ownership of their learning. The feedback they receive is then more receptive because it was initiated in a positive environment.
Matt Celmar said...
Observation and feedback are two things in the medical field that that I think we do no practice enough. As a teacher of new staff, one of the most helpful things I can do is give someone feedback from an observation in a high yield situation. New staff wants to know if they are performing a task or handling a situation correctly. Giving them structured feedback in the moment and afterwards directly pertains to what they are trying to learn and their skill acquisition.
I had the opportunity to employ the ask-tell-ask method, structured observation, and feedback on the day of our last class. Having the information from the morning fresh in my head I approached my feedback with my new staff from a different angle.
I began with the ask-tell-ask method of feedback. The staff and I discussed their progression through the training process at the Center for Autism. To my surprise, the staff brought up almost everything that I wanted to discuss with them about their progression. They expressed their concerns and achievements with little direction from myself. Ask-tell-ask allowed them to come to conclusions and evaluations about their performance on their own.
Maged Argalious
It is obvious that the ask-tell-ask method is popular with most clinicians. Unlike some of the adult education theories that are hard to apply in day to day clinical teaching, this method can actually be used in a busy clinical setting. Asking the learner helps the teacher understand the learner's thoughts and sets the goals and objectives of the interaction. A more tailored approach can then be taken that identifies the learner's needs.A more targeted feedback can then follow
The Ask-Tell-Ask and direct observation model is a very effective model for reinforcement or corrections of needed behavior changes. It provides meaningful and timely feedback for learners and immediately connects them with alternatives for improvement. If the learner is unaware of problems or ways to improve it brights these issues to the surface for discussion and problem-solving dialogue. As Gallup and other initiatives support recognition, this allows for genuine and meaningful content to recognize and compliment. The challenge for educators is this model requires deliberation and time. The educator needs to contemplate their delivery of feedback and relay with diplomacy an sensitivity but the pay off is high. This model immediately connects the action with education and will likely be recalled for future situations.
Previous comments were from Shelley
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