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Models of giving feedback

A common model for giving feedback in clinical education settings that you may have come across was developed by Pendleton (1984).

Pendleton’s rules

1. Check the learner wants and is ready for feedback.

2. Let the learner give comments/background to the material that is being assessed.

3. The learner states what was done well.

4. The observer(s) state what was done well.

5. The learner states what could be improved.

6. The observer(s) state how it could be improved.

7. An action plan for improvement is made.

Although this model provides a useful framework, there have been some criticisms of its rigid and formulaic nature and a number of different models have been developed for giving feedback in a structured and positive way. These include reflecting observations in a chronological fashion, replaying the events that occurred during the session back to the learner. This can be helpful for short feedback sessions, but you can become bogged down in detail during long sessions. Another model is the ‘feedback sandwich’, which starts and ends with positive feedback. 

When giving feedback to individuals or groups, an interactive approach is deemed to be most helpful. This helps to develop a dialogue between the learner and the person giving feedback and builds on the learners’ own self-assessment, it is collaborative and helps learners take responsibility for their own learning. 

A structured approach ensures that both trainees and trainers know what is expected of them during the feedback sessions. Walsh (2005) and Vassilas and Ho (2000) describe a model adapted from Kurtz et al. (1998), summarising the key points for problem-based analysis in giving feedback to groups as follows.

  • Start with the trainee’s agenda.
  • Look at the outcomes that the interview is trying to achieve.
  • Encourage self-assessment and self-problem solving first.
  • Involve the whole group in problem solving.    
  • Use descriptive feedback.
  • Feedback should be balanced (what worked and what could be done differently).
  • Suggest alternatives.
  • Rehearse suggestions through role-play.
  • Be supportive.
  • The interview is a valuable tool for the whole group.
  • Introduce concepts, principles and research evidence as opportunities arise.
  • At the end, structure and summarise what has been learnt.

Vassilas and Ho (2000) identify that medical educationalists claim that using this method for groups and individuals is more likely to motivate adults, in particular, to learn. Initially, grasping this different way of working can be more difficult for trainers than using the traditional didactic approach, but research into using this method supports its effectiveness in clinical settings. The widely used Calgary-Cambridge approach to communication skills teaching (Silverman et al., 1996) is referred to by Walsh (2005) in his summary of ‘agenda-led, outcomes-based analysis’: ‘Teachers start with the learners’ agenda and ask them what problems they experienced and what help they would like. Then you look at the outcomes that they are trying to achieve. Next you encourage them to solve the problems and then you get the trainer and eventually the whole group involved. Feedback should be descriptive rather than judgmental and should also be balanced and objective.’

See also the Teachers’ toolbox for a summary of Giving and receiving feedback.

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