Performance Feedback

Performance feedback is information conveyed between a rural preceptor and a student, concerning his/her performance in the practice environment.

Effective performance feedback is a two-way communication mechanism, which leads to shared understanding of the required level of performance, and promotes and supports the learning process by providing students with the opportunity to enhance or modify their future clinical performance.

Providing performance feedback can prove one of the most difficult, demanding and complex tasks facing anyone in any form of teaching, management or other supervisory role. However, as health care workers the ability to provide constructive feedback is regarded as a core professional requirement of competence.

The objective of effective performance feedback should be to impart the necessary information in a fair, helpful and sensitive manner and to allow for a two-way communication flow.

Feedback provides an opportunity for students to gain insight into the way performance is perceived by others, and to seek information and advice on areas that may require change. The following guidelines include advice on both the giving and receiving of feedback and details on how to use questions effectively in these processes

Giving feedback to students:

• say something positive to begin and end with;
• comment on the actual behaviour observed;
• avoid vague general statements;
• make it relevant;
• choose your time and place;
• don’t advise or judge;
• use feedback sparingly, and
• don’t forget that feedback also says something about the person giving it.

Receiving feedback from students:

• listen to the comments;
• avoid defensiveness—do not make excuses;
• ask for clarification;
• get a balanced view— see if others think the same;
• ask for feedback if it does not seem forthcoming;
• decide what use you can make of the comments;
• consider how important the comments are to you; and
• thank the student for the feedback.

Phases of Feedback

There are three phases of performance feedback:

Opening
The exchange of performance feedback is an anxiety producing exercise for both the student and the preceptor. It is especially important at this time to create a supportive environment.

The key principle during the opening phase is to make clear the purpose of the session, and the reasons for it. Dialogue can then be given, and is often best begun by the establishment of common ground. At this stage, it is extremely important that the feedback process focus on the issues rather than personalities, that comparisons are not made with others, and that jokes or sarcastic comments be avoided—the former can backfire in a stressful situation. The better the two parties know each other, the more likely they are to predict each other’s responses and to structure the discussion effectively.

Content
During this phase, effective communication is a crucial factor for the

giver to possess, in determining the degree of success of the feedback session. Two major aspects of this phase include asking questions and facilitating two-way dialogue. Questions obtain information, encourage responses from the other person and an increased understanding of their viewpoint, motives and needs.

Closing
The final phase provides the opportunity for the key points of the feedback to be summarised, and agreement on a course of action reached. The feedback session should be terminated by thanking the student for their attendance.

Using Questions When Giving Feedback

Giving and receiving feedback will be more effective if a rapport exists between the clinical supervisor and the student. A trusting and warm rapport will foster the exchange of genuine information. Providing feedback that may be received as negative is difficult. Skilful phrasing of statements and selection of question style can help.

Open Questions

• Tell me about ...?
• Can you tell me why ...?

Open questions require students to provide a relatively detailed response, which enables you to concentrate on listening carefully to what is being said. If the answer the student provides lacks clarity or you wish to know further information, it can be useful to probe a little deeper into the subject.

Probe Questions

• Why do you think…?
• Can you expand a little more on that?

The use of silent pauses, and small nodding gestures can also be used to indicate to the student that you expect more information. To ensure that the conversation is flowing logically, it is sometimes useful to link some of the student’s key statements with the topic you wish to discuss.

Link Questions

• You said that you find it difficult to discuss difficult issues with your patients. What are your views on …?

Closed Questions

• Would you agree that…?
• So you believe …?

Closed questions are aptly named because they will commonly be answered with a short and closed answer, such as yes or no. As this type of questioning is unlikely to clarify or resolve issues, they should be avoided, unless you are:

• collecting facts
• summarising a long response
• summarising agreements in an attempt to terminate the interview.

The key to choosing the most effective type of question depends upon your listening ability.

Active Listening Skills

Attending:

• establish contact
• maintain a natural, relaxed posture
• employ natural non verbal gestures
• ensure verbal responses are relevant

Paraphrasing:

• listen for the key message
• reword the key message simply to validate understanding
• observe cues or ask questions to confirm your understanding.

Clarifying:

• confess you do not understand
• ask the student to repeat or rephrase his/her issue
• allow the other person to correct your perception if it was inaccurate
• ask open-ended questions to encourage description.