Doctor Coach

Don't teach more, coach better!

Discussing Feedback

Effective feedback requires an ongoing dialogue between the coach and the learner in order to provide the learner with relevant external data that can be used to guide their skills practice.

The importance of dialogue

One of the keys to making feedback effective is not to simply "give" feedback, but rather to use feedback to engage your learner in a dialogue about his/her performance.  This conversation about your learner's performance helps you as the coach to focus your feedback on the most important learner needs, provide the right amount of reinforcing or corrective feedback, ensure that the learner understands the feedback, and create a plan to help the learner address his/her barriers to progressing to the next milestone.

Understanding the ask-tell-ask framework

Ask-Tell-Ask is a framework that helps you as the coach to engage in a dialogue with your learner about his/her performance.

ASK: Begin feedback by asking your learner to reflect on or describe his/her performance.  You may start the discussion with an very open ended question like "how did it go?" but should quickly be prepared to help the learner to narrow his/her focus from the entire encounter to a component or specific skill.  In some instances, you might instead focus from the start on asking the learner about his/her performance of a specific previously agreed upon skill or major area that you want to discuss.  The better you understand the learner's perspective the better able you will be to chose what advice to give the learner.

TELL: After you understand the learner's perspective, you should affirm his/her self-assessment when you agree.  Then, you should describe your observations in terms of observable learner behaviors and their outcomes for the learner, patient/family, other team members or encounter as a whole.  If it takes a lot of discussion to help the learner to understand your observations, you might need to focus your work in the future on providing the learner with additional examples of your observations.

TELL: Once you have discussed the learner's performance, you should talk about the next steps s/he should be striving for by deconstructing your own expertise to describe how you personally have achieved that next step or describe what you would have done differently. 

ASK: After you have talked about your observations and next steps, ask the learner to summarize the major feedback points so that you can assess his/her understanding.  This should certainly happen at the end of the feedback dialog, but may also need to happen throughout as well.

ASK: Conclude by asking the learner how s/he plans to address the major feedback points in the future.  You should also ask the learner about his or her perceived barriers to reaching that next step and help him or her problem solve how to address or circumvent them.

Prepare for feedback

Although you should always start feedback by asking, you can only prepare for feedback by first planning to tell and then deriving the questions to ask from that synthesized assessment. 

Prepare to tell

Prepare for feedback by considering the most important learner strengths and weaknesses, your suggested strategies for improvement, and how to discuss them with the learner. Assessing Learner Performance outlines this process in more detail.

Prepare to ask by using facilitated reflection

Rather than just telling a learner something that you know or have observed, you as the coach can help him/her discover what you already know.  This process may help your learner to better understand and internalize your observations if s/he is able to articulate them him-/her-self.  S/he may also be more motivated to work on the lessons that s/he "discovers" more so than ones that s/he does not fully understand.  To find out what your learner thinks, you should start off with an open-ended question (just as you would when interviewing a patient).  You might ask, "how do you think the encounter went," or ask about a specific aspect of the encounter.  This opening allows the learner to identify his/her primary agenda for your feedback discussion.  Often s/he will identify the issues that you wanted to discuss.  You might need to ask additional questions to clarify the details, but your job is easier because you are already on the same page with the learner. 

On the other hand, when the learner does not identify the same issues that you had prepared to talk about, you should at minimum acknowledge his/her perspective.  You might choose to shift your plans to focus in on the learner's primary concerns and save your assessment for another discussion or decide that your assessment supersedes his/hers as being most essential to talk about.  For the latter, you should ask some additional questions to give the learner a chance to discover your observations. 

Prior to the feedback discussion, you should think about at least a few progressively more specific or close-ended questions that you might need to ask the learner during the discussion.  One way to anticipate the discussion and think about what kinds of questions you might need to ask is to think about what questions you have about the learner's performance.  You might wonder if his/her performance is typical or an outliner, what his/her thought process was behind a certain action, or what barriers s/he has to reaching the next steps.  Asking these types of questions will help you to understand his/her perspective and better know how to frame your assessment for the learner.

When you are prepared, it is much easier to ask the "right" questions when discussing feedback.  While this preparation does take some time, it often makes the feedback dialog more efficient and effective.  Over time as you practice preparing for feedback, you will be able to do so more quickly.

The final ask: Summarize feedback and plan for practice

This is one of the aspects of feedback that is often forgotten; yet making a plan about what to do with feedback is often what makes the feedback useful or able to be acted on.

An effective practice plan begins with 
Establishing the Practice Objectives.