Doctor Coach

Don't teach more, coach better!

Assessing Performance

Synthesizing observations based on milestone achievement focuses the assessment on which aspects of the performance to reinforce and to correct when planning learner feedback.

Synthesize your performance observations

The first step in developing a unified learner assessment is to synthesize and integrate your performance observation data. Use the relevant milestones list and learner goals to help you edit - filtering out less relevant observations, and helping you gain meaning from your observations. This can be complex, but doctors are well trained for this task. Think of how you synthesize the data from a patient history, physical exam, and laboratory findings into a unified patient assessment – using a standardized approach learned in medical school. Similarly, synthesizing a learner assessment is made easier both by using tools to systematically obtain and focus performance observation data (i.e. milestones and learner goals), as well as a standard method of analysis: reinforcing and corrective feedback.

Decide what to reinforce

Reinforcing feedback tells learners what component skills they are doing correctly and should continue to focus on performaing the same way. This type of feedback is particularly critical to novice learners to ensure that correct performance “sticks” and is not unintentionally extinguished. These component skills are a given learner’s strengths, and provide the important foundation upon which their new skills will be built. Moreover, providing specific reinforcing feedback helps a coach avoid giving generic “positive feedback.” Interestingly, providing effective reinforcing feedback is often more difficult for coaches than providing corrective feedback. Using specific milestones checklists will help you to develop this important coaching skill.

In providing reinforcing feedback, choose skill components that are:

  • Fully mastered (particularly if the learner questions their ability during self-assessment).
  • Fundamental to success at the learner's current milestone level.
  • Skills that are just at a new level of mastery, and/or will promote the learner's progression to the next skill milestone level.
  • A particular or unique strength of this learner, especially if it can be built upon to help him or her work on areas of corrective feedback.

Be sure to frame your feedback in terms of the behaviors and patient reactions or outcomes you observed in order to avoid bias and improve specificity.

Decide what to correct

Corrective feedback tells learners what component skills they are performing incorrectly, incompletely, or not at all. This type of feedback is particularly critical to more advanced learners to ensure that incorrect technique is not perpetuated unwittingly. Rather than “weaknesses,” these skill components are often the ones that are holding the learner back from further skill advancement. Providing specific correct feedback that will help the learner move to the next skill level avoids labeling this as “negative feedback.” The challenge for coaches is to avoid giving feedback on component skills that are well above the learner’s current developmental skill level. The learner is not yet ready to work on these skills and feedback about them has the potential to either distract the learner from what s/he needs to work on or lead to defensiveness.

Additionally, without deliberate selection of reinforcing and corrective feedback, coaches are at risk of switching observation lenses and to provide corrective feedback on different skills than were originally agreed upon. These less effective feedback behaviors can lead to a significant deterioration in the coaching relationship and learner sense of trust. Again, using specific milestones checklists will help you to develop this important coaching skill.

In providing corrective feedback, choose skill components that are:

  • Only partially mastered
  • Done incorrectly and at or below the learner’s current milestone level
  • Holding the learner back from progressing to the next milestone level
  • Interfering with a relative learner strength
  • A significant breach in professionalism, doctor-patient communication or patient safety that a learner at this level should have been expected to perform correctly, irrespective of the agreed upon skills.

Be sure to frame your feedback in terms of the observed behaviors and patient reactions or outcomes you observed in order to avoid bias and improve specificity.

Plan for feedback

Select and integrate the most relevant reinforcing and corrective feedback into an integrated assessment prior to your feedback conversation with the learner. In general, novices require more reinforcing feedback while advanced learners benefit from more corrective feedback. Guidelines for ratios of reinforcing-to-corrective feedback:

  • Novice to advanced beginner: 3:1
  • Advanced beginner to proficient: 2:2
  • Proficient to competent: 1:3
  • Competent to expert: 0:4

Organize your thoughts and notes, and plan to frame your feedback around the behaviors and patient reactions or outcomes that you observed. List any questions that you still have or additional information that you want to obtain either from additional observation or by asking the learner about his/her perspective.


These questions will help you plan to
Discuss Feedback with your learner.