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What is Feedback?

Telling a fellow student that they are doing a good job is usually easier than criticizing them. However, criticism in a constructive form is indispensable for improving one's own performance. Giving constructive feedback is an important communication skill for all physicians when dealing with students and colleagues. But how do I give good feedback and what exactly is it anyway?

"I don't know what I have said until I have heard the answer of my counterpart" (Paul Watzlawick).

With the help of feedback, employees, students and even entire teams can be successfully supported in their clinical competence and collaboration.

Why use the feedback method? In general, feedback serves to give another person or even a team feedback about demonstrated behavior and its effect. However, sometimes giving or receiving feedback can be a difficult situation for those involved. This is especially true when criticism is received or expressed.

However, feedback conversations can be constructive and beneficial if they are seen as an opportunity to share and develop personal or professional skills.

What exactly does feedback mean?
Feedback initially means nothing more than "feedback" or "feedback". Behind this, however, lies a rather demanding task, both for the feedback giver and the feedback receiver.

The feedback should relate to observable behavior in a concrete and limited situation. The focus is on ensuring that it is profitable and beneficial for the feedback recipient. It is therefore about a constructive discussion of differences in the self-assessment and external assessment of behavior.

The feedback giver has the task of making an accurate assessment of the other person's behavior. This must be reported back in a way that is understandable and acceptable to the other person.
The feedback receiver is initially in a passive role. His or her task is to listen to the other person and compare his or her impressions and interpretations of the observed behavior with his or her own perception.

The sandwich technique
First, by naming positive aspects, the aim is to ensure that the counterpart is willing to engage with the feedback and also with critical aspects. Only then are concrete observations summarized, their effect on the feedback giver described and suggestions for changes given. Finally, a summary is given again, in which especially positive aspects should be emphasized.

The "cookie lemon cookie" principle:
This is a similar principle to the sandwich technique. The criticism (i.e., the lemon) should be enclosed by positive aspects (the cookies).

The Pendleton model:
According to this model, feedback consists of four steps:

Step: The feedback receiver first names himself which areas of his demonstrated behavior or performance he would judge as good.
Step: The feedback provider identifies the areas in which he agrees with the self-assessment of the feedback recipient and completes it.
Step: Now the feedback recipient names the areas in which he was dissatisfied with his performance and which could be improved.
Step 3: Finally, the feedback provider names specific points in which he sees a need for change or improvement.

Good feedback is acceptable and motivating for the feedback recipient. If this is fulfilled, even very critical aspects can be addressed openly.
The feedback giver's task is to perceive those specific behaviors that he or she considers significant for the task at hand. Significance can relate to professional judgment, but also to personal impressions or preferences.

Good, constructive feedback should be....

be descriptive, not evaluative.
be formulated in a factual manner.
Be supportive and appreciative.
relate to specific, observable behavior, not to a person and his or her characteristics.
be formulated subjectively, i.e. own evaluations and interpretations should be recognizable as such (I-messages).
refer to aspects that can be changed.
consider positive and negative aspects and describe them precisely.
contain concrete suggestions for change or improvement.
take place in a timely manner.
take place in a personal one-on-one meeting or, in the case of teams, in a previously defined setting.
A few examples
"I liked very much that you informed the patient in situation XY extensively about risks of the treatment method. I thought that was an appropriate way to deal with patients. However, I had the impression that the patient did not always understand everything correctly. This can be avoided if you use as few technical terms as possible."
"E.g. in this really difficult situation XY you reacted very well and showed empathy and understanding."
"You always prepared really well for class by looking at the e-learning units and printing out important information. That's why you were always able to collaborate so great in class."
"This was a really critical and difficult situation. You responded well and quickly by doing XY. At the same time, I think you should avoid XZ."
"That was a very successful relatives talk. I especially liked that you emphasized XY."

Even well-intentioned feedback can be unhelpful if it is not worded constructively and precisely enough.

A few examples:

  • "Considering that block instruction is always very demanding, you did a good job."
  • "You did everything great, keep it up!"
  • "You could have talked to the patient a bit more, that's not going to work."
  • "You should practice talking to patients a bit more, otherwise everything is great."
  • "The educational talk was okay. The patient didn't really understand you, though."
  • "The wound care was good. You should talk to the patients more."
  • "For the fact that the situation was so difficult, you handled it well."
  • "You should practice placing the brown line again, otherwise it was good."
  • "That was really great, my compliments!

The feedback recipient initially simply listens. Many people find this extremely difficult, especially in situations where they are exposed to criticism.

The feedback recipient should ...
not justify or defend himself. It is quite natural that self-assessment and assessment by others differ.
let the other person speak.
ask questions of understanding if things are unclear to him.
Consider feedback as valuable feedback and accept it appreciatively.
forgive the feedback giver for mistakes.
The feedback recipient can accept the feedback, but may also reject it. It is his or her responsibility to decide which aspects of the feedback he or she would like to take into account in the future and incorporate into a change in behavior.

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