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Giving informal feedback: maximising opportunities

There are many opportunities for giving informal feedback to learners on a day-to-day basis. Spencer’s article ‘Learning and teaching in the clinical environment’ (2003) describes a range of aspects and activities concerned with helping clinical teachers to optimise teaching and learning opportunities that arise in daily practice, such as planning, using appropriate questioning techniques and teaching in different clinical contexts. Such techniques often involve giving feedback to learners on their performance or understanding, but the feedback is built into everyday practice.  Those giving feedback can help the learner to move through the stages in the ‘competency model’ of supervision (Proctor, 2001; Hill, 2007) as shown in the table below.

 

 

  Unconscious
incompetence

Concious
incompetence

Conscious
competence

Unconscious
competence

Learner Low level of competence. Unaware of failings Low level of competence. Aware of failings but not having full skills to correct them Demonstrates competence but skills not fully internalised  or integrated. Has to think about activities Carries out tasks with conscious thought. Skills internalised and routine.
Little or no conscious awareness of detailed processes involved in activities  
Feedback 
giver
Helps learner to recognise weaknesses, identify areas for development and become conscious of incompetence Helps learner to develop and refine skills, reinforces good practice and competence, demonstrates skills Helps learner to develop and refine skills, reinforces good practice and competence through positive regular feedback Raises awareness of detail and unpacks processes for more advanced learning, notes any areas of weakness/bad habit 

 

Hesketh and Laidlaw (2003) note that providing informal on-the-job feedback can take only a few minutes of the clinician’s time. To be the most effective, feedback should take place at the time of the activity or as soon as possible after so that the learner (and teacher) can remember the events accurately. The feedback should be positive and specific, focusing on the trainee’s strengths and helping to reinforce desirable behaviour: ‘You maintained eye contact with Mrs X during the consultation, I feel this helped to reassure her…’. 

Negative feedback should also be specific and non-judgemental, possibly offering a suggestion: ‘Have you thought of approaching the patient in such a way…’. Focus on some of the positive aspects before the areas for improvement: ‘You picked up most of the key points in the history, including X and Y, but you did not ask about Z…’. Avoid giving negative feedback in front of other people, especially patients. 

Keep the dialogue moving with open-ended questions: ‘How do you think that went?’, which can be followed up with more probing questions.  Hesketh and Laidlaw (2003) also suggest that learners should be encouraged to ‘seek feedback themselves from others… feedback actually works best when it is sought’.

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