Introduction
We all need feedback in our lives and in our professions. This is why we have time with our supervisors and annual performance evaluations, but often we need more ongoing feedback. We are going to start out with three case studies to get your brain thinking along the lines of feedback, and at the end, we are going to finish up with these same case studies and look at some questions that go along with them.
Case Study Examples
Peacemaker.
It's only 6 am, and Sarah, a fieldwork educator, already dreads the 12:00 noon meeting with her OT student and the Academic Fieldwork Coordinator from the college. The meeting was requested by the AFWC because on week 6 of a 12-week rotation, her student, Ronnie, is failing. Sarah is a people-pleaser and peacemaker. She avoids confrontation and craves harmony, which is one of the reasons she chose OT as a profession.
The "Easy A".
Janet is a confident, contentious fieldwork student. She demonstrates very good professional behaviors and learns quickly. Shelly is relieved to have a “good student” who seems to not need much supervision. In fact, she is so impressed with Janet that she decides early on to give Janet an “A”. Shelly consistently scores Janet each week with the highest rating. While Janet is pleased with her high scores, she knows she still has much to learn, and wishes Shelly would help her identify areas for improvement.
The Drill Sergeant.
Haley is in her third week of her level II FW, and is already feeling overwhelmed and that she can do nothing to please her FW Ed, Suzanne. Haley spends time at home each evening working on projects, finding relevant research, and preparing for the next day at FW. Haley also feels that she is doing many things right, but cringes when Suzanne belittles her in front of the patients. Suzanne takes her role as FW Ed very seriously, and has been teased by co-workers that she is too much like a “drill sergeant”. She resents that title, because she is responsible to help Haley be ready for entry-level practice and every minute counts. And besides, her own FW Educators rode her hard, so why shouldn’t she do the same?
Barriers & Solutions for FW Education
Now, you may be thinking already, well some of these situations and these scenarios may sound a little familiar or you could see them occurring. We hope to get to the bottom of all of those by the end of this hour today. So, just to clarify a few abbreviations, the AFWC is the Academic Fieldwork Coordinator, that's the person at the college who is in charge of placing students and coordinating between the fieldwork sites, Fieldwork Educator, and the student, they're the liaison. And then the Fieldwork Ed is the Fieldwork Educator, that's you, who takes the student. So in Hanson, in 2011, found that there's a lack of preparation for the role of being a Fieldwork Educator, and that was perceived as a barrier to being able to work with students. Chapman, in 2016, found that training and education in being a Fieldwork Educator could assist you to improve student growth. So, two very good reasons that you are joining us today, to learn more about how to give feedback so you can be more effective in what you do.
Communication
Unless you want to live on a deserted island, communication is important. In 2007, Quilligan found that effective communication is the leading tool to promote a successful fieldwork experience. If this is the leading tool to promote successful fieldwork experience, we should really be paying more attention to effective communication. Here is a traditional communication scenario in Figure 1.
Figure 1. Communication feedback loop.
Someone sends a message and that message may be written or verbal. The receiver then takes that information, and it is up to that person to interpret that. They can interpret that in a wide variety of ways depending upon how that message is perceived and how it is sent. Then the receiver, who gets that message, gives some feedback to the sender. A fieldwork educator and a fieldwork student could be a sender or a receiver in a communication scenario, and often play both roles. With all of the interpretation that goes on, you can see that it could get a little tricky to have effective communication.
Positive Uses of Feedback
There are some very positive uses for feedback. Feedback helps to clearly and effectively communicate strengths and areas for improvement, and both are important. Students need to hear what they are doing well, but they also need to understand what areas they can improve upon. It is also going to help the student reach their goals. The student may have personal goals, goals that the college puts on them, and then they may have goals that you have encouraged them to have at your site. Feedback helps drive that student to get to those goals. It also can ensure patient safety, which is our number one priority in healthcare. Feedback can promote self-reflection for our students and establish a collaborative relationship, which we definitely want in healthcare.
Negative Uses of Feedback
Unfortunately, there are some negative uses of feedback. Feedback is a continuum, and we hope that most people are on the positive side of that continuum, but I am sure you all have seen cases where feedback is used to show off knowledge and make the other person feel less important or less knowledgeable. Sometimes that can happen in an educator-student role, and we have to be careful of that. There are cases where the student may feel criticized or shamed by the fieldwork educator, and we do not ever want that to happen.
Consequences of No Feedback (MacLean, 2016)
What if there is no feedback?
- Good practice is not reinforced
- Poor performance is not corrected
- The path to improvement is not identified
- Learners assume all is well
- Learners have to guess their level of competence
- Learners may have to learn by trial and error at the patient’s expense
In case study of the one fieldwork educator who was not giving any feedback to the student, good practice was not being reinforced. The student did not know if she should continue down a certain path as she was not receiving that positive reinforcement on that good practice, and then conversely, any poor performance was not being corrected. If we do not give that feedback, we may be helping them to think what they are doing is fine. We are also not enlightening that path to improvement, or helping to shed light on the goals of where that student can grow. Fieldwork should be an opportunity for a lot of growth in a student. Perhaps one of the biggest is that learners assume all is well. There is definitely "fixing" that has to happen in fieldwork, as that is part of what it is. Learners have to guess the following: "Am I competent? Did that transfer go well? Did that treatment session go well? How competent am I if I don't have any feedback? Where I am in the progression towards my goals? What does entry-level practice looks like?" Without that feedback, there is trial and error. Certainly, there is going to be trial and error, but it does not need to be at the patient's expense. The fieldwork educator, who does not give feedback, really could be putting that patient at risk and missing that opportunity for the student to be learning.
Quality and Timeliness
It has been shown that student satisfaction with that fieldwork experience improves if we give them timely and high quality feedback (Chapman, 2016).
- In private
- Timely – don’t wait too long
- Routinely provided
- Accurate
- Factual – it’s about the observable behavior
- Clear (specific)
- Relevant to goals
- Descriptive
Feedback should always be given in private unless there is an emergency situation that requires intervention. We certainly do not want to be giving feedback in front of other people and be respectful of our students. We should be timely and not wait too long. We need to correct things, and do not let them go on so they become habits and routines for our students. They also may forget what they did if we do not give them that timely feedback. It should be routine, and we should set aside a time weekly or daily; some time to check in with that student. They may need it at the end of each treatment session as they are progressing towards entry-level practice. You have to figure out with your student based on your schedules. It has to be factual and be observable behavior, not about what you feel or you know. It also has to be clear and specific. Later, we are going to go over useful and unuseful feedback. Many times the feedback is not specific enough. The feedback should be related to the goals. These are goals that the student has set, the college has set, and that you set together for that student's progress in the fieldwork. Finally, it should be descriptive. We need to give them more than, "Hey, that was just a good job," or "You need to improve on that." Tell them specifically why.
Is It Our Ethical Responsibility?
The 2015 Code of Ethics from AOTA talks about beneficence, doing good, and gives the example of ensuring that fieldwork education is congruent with the skills that they need.
- Beneficence
- Do good, ensure that FW education is congruent with skills
- Nonmaleficence
- Do no harm to clients or students, recognize issues that may impact students
- Autonomy
- Including confidentiality (HIPAA, FERPA)
- Justice
- Fairness, objectivity, follow laws, provide appropriate supervision
- Veracity
- Objective, accurate information
- Fidelity
- Respect, fairness, discretion, & integrity
For beneficience, we are educating them according to those skills to do good. Nonmaleficence is to do no harm to clients or students. We need to recognize issues that may impact students. If we are not giving adequate and appropriate feedback, we are not recognizing those issues; those areas where students could be improving and where they are doing well. This could be harming their progress as a student. Autonomy is also important. It goes along with the location of feedback, making sure that we give it in private. It also goes along with our laws that govern us, HIPA and FERPA. FERPA is the Federal Education Rights that students have to their privacy for their educational record, thus you only need to be talking to the student. The rest of that team does not need to know what is going on with that student unless they are a part of that evaluation process and they have also been identified as secondary supervisors to the student. The student has the right to privacy. Justice is being fair, being objective, following the laws, and providing appropriate supervision. Veracity is to be held truthful, and give objective and accurate information. Fidelity is respect, fairness, discretion, and integrity. These are our ethical principles, and yes, they certainly do support giving feedback to students.
3 Steps to Giving Feedback (MacLean, 2016)
There are many different strategies for feedback, but this is the one that I like to follow, shown in Figure 2.
Figure 2. Three steps to giving feedback.
It is laying the foundation, preparing the details, and delivering the message, in that order.
Laying the foundation.
- Establish rapport & professional relationship
- Set expectations - when, where, how often, & be clear
- Identify how learner desires feedback
Laying the foundation starts with establishing rapport and a professional relationship with the student. This takes time and some work. We are already busy as clinicians and then when we add a student to our workload. It can be challenging, but please take the time to do establish that rapport and that professional relationship with the student to be able to give them feedback. That will setup a trusting relationship so they will be more open to receiving the feedback from you when you give it to them. You need to also set the expectations. They need to know when they will be receiving feedback from you and where you will do it. We need to be very clear and upfront with the student about that. I also think it is important to think about how the student desires feedback. Do they prefer to read it first before you have a sit-down meeting? This is an example of formal feedback. Informal feedback is in the moment or directly after a treatment where you would not need to have everything written down for the student, but for more important feedback, you want to make sure that you understand how that student prefers to receive that.
Prepare the specific details.
- Organize thoughts and data ahead of time
- Based on student’s goals
- Select appropriate time and location
- Prepare for varied reactions
- May need to involve AFWC
The second step is preparing the details. You want to be organized and gather your data ahead of time, which means during your time as a fieldwork educator. You need to take the time to jot down thoughts and keep track of things that the student is doing or not doing. I will share a resource with you later on how to do that. We go back to the goals. Everything in occupational therapy is based on the goals, so that feedback needs to be based on the student's goals. We need to select the appropriate time and location. Let's say you are going to do a midterm evaluation (formal type of feedback). In those details, you need to set the time and location. "We will meet in my office at 10 o'clock on Tuesday to give go over this feedback." Be mindful of reactions that the student might have to that feedback. They could be different than what you are expecting. Remember, they are also interpreting that feedback in real time that you are giving, and have not read it beforehand. It might take them time to process that information. Prepare for varied reactions. You may have something very hard to share with them, like they are not progressing, you have to extend their fieldwork, or they have not met a specific competency. Be mindful of how they may react. Do you need to involve the academic fieldwork coordinator? Schools prefer to be aware of challenges as they arise; sooner rather than later. If you are thinking that you need to involve the academic fieldwork coordinator, you probably should plan for involving them.
Deliver the feedback.
- Non-judgmental, non-biased
- Specific
- Allow student to share thoughts & self-reflect
- Give in small, actionable amounts
The third step is delivering the feedback. When you are delivering it, you want to make sure that it is non-judgmental and non-biased. It also needs to be very specific. During that feedback session, you need to give the student an opportunity to share their thoughts and to self-reflect. We also need to give them feedback in small, actionable amounts. If you come at them with 10 things that they need to change by next week, they may be overwhelmed. I would encourage you to prioritize the things that need to come first, or perhaps the things that you think they can achieve sooner, and then have another feedback session to follow up on that feedback and their progress.
