Marshall Solomon, DPM
Director of Podiatric Medical Education
Chairman, Department of Podiatric Medicine & Surgery
Farmington Hills, MI
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Moderator: –to be covered are going to be with the life skills talks that we’ve shared with you over the last couple of days, and our first one is going to be given by Dr. Marshall Solomon talking Feedback – The key to knowledge, Skills and Professional Attitude, so please welcome Dr. Solomon.
Dr. Solomon: I just want to mention that I always look forward to coming to this seminar every year, I think it's a dynamic seminar, I think it’s extremely beneficial for residents and attending faculty and my hope is that it continues and expands because it's a great seminar. I want to talk about something that I am very passionate about. As a residency director I feel that it's really important to understand the concept of feedback especially when you're training residents and I'm going to expand this a little bit into clinical care on a professional level, of course I do want to thank my resident Jeff Pentek for organizing it and I will not take credit for any of the pictures that are in it that are all his.
So we’ll move along. This session we are going cover this in a short period of time, I’m going to talk about what the definition of feedback is, the importance of feedback in residency training, methods of feedback. How is meaningful feedback given and how residents should be requesting feedback and then feedback in clinical practice and we’ll conclude.
Essentially feedback by definition is used in context of human performance. Feedback is the process of giving learners information about current performance so they may improve it in the future. Giving feedback is probably the most assertive thing that you can do as a physician teacher and ensure to really moving into more confrontational type of mode which is actually interacting in the actual behavior or clinical portion of the residence training.
Feedback can be positive and it can be negative but it is feedback. And positive feedback reinforces good behavior; negative feedback helps change bad behavior but really this is not the definition of medical feedback. Really medical feedback is to inform to give provide judgment and make observations to help the resident make improvements in their clinical and surgical knowledge and skill. So there are three characteristics of feedback.
The first characteristic is that feedback should be descriptive rather than be evaluative. So descriptive feedback helps the resident provide really precise unarguable point of view to help them improve.
The second is feedback should be specific as possible not just meandering all over the board. And third it should well-timed. Feedback a month later is meaningless to a resident unless you can and it is really better for it to occur as soon as possible. And you need to understand that feedback is both positive and we love to get a lot of positive feedback but negative can be just as important as the positive feedback.
So let’s talk about the importance of feedback in residency training. Again as I mentioned it's going to be both positive and negative. And it's a way of overall assessing the resident’s clinical and didactic performance. Feedback gives the resident direction in their knowledge and skills both in their podiatric care and their surgical care. And feedback also demonstrates a – we can accomplish that through mentoring as teaching faculty we can mentor them in professional attitudes and developing a good judgment.
It also allows the resident to have this feedback among their resident colleagues, attendings and administration at the hospital. And more importantly there is feedback that occurs with patients. And we talk about this concept of 360 degree evaluation and assessment. Putting the patients into their feedback assessment is very critical to the residents’ development, professional development.
So some methods of feedback. They can be formative which is a valuation to improve performance and it can be summative evaluation which determines competency promotion and advancement. So we generally are required by our CPME 320 now to evaluate formally semiannually but most hospitals will ask you to evaluate your residents on a quarterly basis. And in that evaluation it generally is written to see what their cognitive and non-cognitive skills have been accomplished during that quarter or semiannually.
You can have it formally face-to-face it is a requirement in our 320 document to sit down at least twice a year and talk to your residents and give them feedback on their on their clinical and surgical skills. It can be case-by-case. On a surgical case you can have a written evaluation form that talks about their intraoperative care of the patient and perioperative care. And this is another form of feedback and assessment for the resident.
And then of course you can have it informal evaluation which can occur almost at any time but that should really be down there is, it's important to give that evaluation and it should be constructive in respect no matter if it's a positive or negative feedback it should always be constructive.
So how is meaningful feedback given? Well I've always felt that if there is going to be some negative feedback as a constructive method along with the positive feedback it should be done privately. It doesn't accomplish anything to embarrass your resident fun of other co-residents or other attendings to make a point or to give feedback to that resident so I think out of respect from one individual to another you should do this in a private area.
And I think it should be done honestly and straightforward. You can't namby-pamby around issues because when you do that you're really losing the focus of what you're trying to do in giving them the feedback that they need. So it should be given constructively by all means you should identify strengths and weaknesses that you have identified in that. Specifically identify the weaknesses giving positive feedback for their strengths and try to interweave their weaknesses in by using the strengths that they have already accomplished.
And you can acknowledge this feedback in their didactic knowledge and you can identify that in their clinical knowledge which is divided between their clinical podiatric and clinical surgical cases. Now all along there is another component of professionalism that is part of this professional attitude and the way you present feedback is a way of showing what professionalism is really about in administering or getting to advise them of their strengths and weaknesses. And I think it's important that it's not done twice a year but it’s done repetitively and constructively. So this allows the resident to actually gauge themselves on this ladder of success that they establish.
So if you're giving them regular feedback they know if they're on the lower rungs of the ladder or they are starting to achieve the platform on top of the ladder that they have to keep [indiscernible] [0:09:39]. And the most important thing is to keep lines of communication. They should always know that if the director wants to speak to them it's not going to be all negative. They should be able to understand that there's going to be positive and negative feedback at that time.
And so again it helps mentor that professionalism and judgment we ultimately want to achieve in a resident. So I think that this is probably the most important concept, this is the concept of identify strengths and weaknesses and just by a quick poll, how many of the residents here actually asked for feedback? Okay so there are some of you. It should be all of you. There is no way that you are really know where you're at unless you ask what you are doing, what are my strengths, what are my weaknesses of course want to find out what your weaknesses are so you can you know, certainly turn those weaknesses into strengths.
So when you are in your rotation be it medical rotations or your surgical rotation maybe after week 10 days certainly not more than two weeks into your rotation you should be asking your trainer, can you identify any weaknesses that I can improve on, you don’t want to be at the end of your rotation and you fail in your rotation because you never asked to try to improve on those things that you were weak in.
I think feedback can come from a [indiscernible] [0:11:16] that doesn't have to be the director alone it could be other of your attending, other teaching faculty in your medical rotations certainly you can get feedback from administration and nursing as well as your co-residents, especially your senior residents that are more experienced.
And again as I touched on it before, patients. I think if you ask the patients in an appropriate way you can get that feedback which is ultimately the most important. And then feedback in clinical practice, for us once you go into practice this is just as important for the success of your practice. You can accomplish that through a variety of ways, one is patient surveys that you hear about all the time you can take that. I think having staff meetings with your assistants and your front office personnel helps get some constructive feedback to enhance patient care, efficiency of the practice, staff productivity and harmony and I think that's real important.
And then you can get informal feedback from your patients and you can do that in a very unique way not by coming out and asking them a series of questions but you can ask them you know, how you feel about the care that you are providing in the office – what can we do better to you know help you and how the staff responds to their podiatric needs and then their overall feeling in the office, so that might be one-to-one and it really does give you more time to talk with your patient which increases the physician-patient bonding that’s very important nowadays.
And then in conclusion I think you must receive feedback as a practitioner and as a resident openly, taking the judgments that are negative just as you take positive because it is a constructive type of feedback. This will help keep pulse of your practice, what you're doing in your residency and always thank your staff for the constructive feedback that they give you. Thank you.