Your Feedback Needs a BOOST!

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George Willis
George Willis
Asst. program director and medical student director, which means he loves to teach at all levels! Lover of all things MedEd. Focus on feedback and teaching on the run. Former D1 football player but now lives out his football dreams vicariously through his sons.

The Pre-brief

Providing feedback can be difficult, and there is certainly an art to providing feedback.  There are several types of feedback and which one you use is really up to your personal preference.  There really isn’t a “best” type of feedback as circumstances may warrant one type of feedback over the other.  However, there is a set of criteria for feedback that I think is paramount for feedback to be maximally effective, and that is the BOOST model: Balanced, Objective, Observed, Specific, Timely.

1) Balanced

Balanced, non-judgmental feedback allows emotion to remain out of feedback, in the receiver and the provider.  Emotion is difficult to eliminate from feedback.  Often, a provider inserts judgment or emotion into feedback which creates a negative or positive tone to feedback, which should not be its intent.  Additionally, a receiver will often immediately put up a defense field and assume any feedback that is coming is negative or critical.  Therefore, eliminating judgment or emotion from feedback keeps the focus on the improvement of the receiver.

 

Here’s an example of feedback that has judgment implied:

“You failed to include aortic dissection in your differential.”

 

Use of the word “fail” implies negativity, regardless of if it was intended or not.  A receiver who receives this feedback is more likely to feel negative about this feedback simply based on the use of “fail.”  Here’s a non-judgmental example of the same feedback:

 

“Don’t forget to consider aortic dissection in your differential.”

 

Here, there are no judgmental words, simply actions or behaviors for the learner to implement.  Giving an action for the receiver to consider will give the receiver a behavior or action to recall for future interactions.  

Another way to interpret the idea of “balanced” is to be sure to give both positive and constructive feedback.  Always giving constructive or corrective feedback can make a learner feel negative about the provider of the feedback.  On the other hand, always providing positive feedback can give the learner an overall impression that the provider is a pushover or too easy.  Therefore, balancing feedback with both positive and corrective feedback either throughout the shift or even during one encounter can maximize focus on the behaviors and take interpersonal emotions out of the equation.

2) Objective

This accentuates the point above that provider of feedback should take emotion out of the equation.  By focusing on more subjective feelings or the provider’s perception of the recipient, again, emotion is invariably inserted.  Here are some examples of subjective feedback:

 

“I feel that your interaction with that patient’s family was pretty bad.”

“It didn’t seem like you cared while you were talking to that patient’s family.”

“You performed that central line rather haphazardly.”

 

Feedback should be focused on actions and behaviors and be objective-based.  It is difficult for a recipient to modify how a provider perceives them.  By focusing on behavior and actions, there are modifiable attributes to the action or behavior that the recipient can focus on for the next interaction.  Here are some examples of how to make the previous examples more objective:

 

“Give the family some time to process what you are saying so they can see if they have questions.”

“Slow down while performing central lines to make sure you aren’t forgetting any steps.”

 

By giving the recipient these actions or behaviors to focus on, during their next patient encounter or the next time they perform a central line, they may incorporate these things into their practice.  

 

3) Observed

This should go without saying.  The provider should only provide feedback on actions/behaviors that are directly observed by them.  A director may be tasked with receiving direct input from co-workers or supervisors of a learner.  While it is incumbent for the director to inform the learner of a summary of this input, it should be given in more of an evaluation form as opposed to feedback.  It should be a summary based on the director’s interpretation of the input provided to them.  While this summary is certainly important for the learner, the director should be careful about attempting to impose modifiable behaviors or actions based on other people’s feedback.  Instead, encourage the colleagues or supervisors to provide their own direct feedback on the observed behavior.  Direct feedback will be much better received and much more effective for the learner.  

4) Specific

Providing vague feedback is almost as useless as providing no feedback at all.  A recipient should be able to receive the feedback and immediately know how to correct themselves if the exact same scenario were to come along in 5 minutes.  That is why it is important for the provider to provide feedback that is specific and to the point.  Here are some examples of vague feedback:

 

“Your differential is lacking.” 

“Speak to your consultants more professionally.”

Or my favorite…

“Good job today!”

 

The way I look at feedback, a recipient shouldn’t be able to ask further questions to make feedback more specific.  For instance, one could ask more questions about each of the vague examples above.  How is the differential lacking?  In what regard?  How did I do a good job today?  Even the second one that has a modifiable action is not specific in what way the recipient could speak more professionally.  More specific versions of the vague examples are as follows:

 

“Be sure to include thyrotoxicosis in your differential for fever and altered mental status.”

“Try not to use curse words when speaking with a consultant.”

“Continue going into rooms to update your patients on their results.”

 

These more specific examples give actions or behaviors for the recipient to include in their next encounter.

5) Timely

As time moves further away from an event, the brain tends to forget.  The same occurs with feedback for both the recipient and the provider.  Waiting days or even hours allow both to forget some salient points that may need correction or reinforcement.  This is why I say feedback is not what’s given at the end of the shift.  It is an evaluation or summary of the day, which should be very simply a recollection of any feedback given during the day.  Feedback should be given in a timely fashion, usually within minutes of the observed behavior or action or even before it if a dangerous action is about to occur.  This maximizes the amount of recall for the recipient and allows them to put the circumstances into perspective.  This may allow them to recall why they performed the action or what was said that caused them to act unprofessionally.  Immediate feedback is preferred, but sometimes a little time is necessary to allow them (or you) to process the event.

The Debrief

So the next time you get ready to deliver some feedback on your next shift, think of how you can BOOST your feedback to make it more effective.

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