1/ All teachers will have learners who aren’t meeting expectations.

Providing feedback in these situations can be tough, but is VITALLY important.

Hang with us, the #MedEdTwagTeam, and we will walk you through it on today’s #TweetorialTuesday!
2/ Today, we will discuss the “struggling learner”, a terrible phrase that shouldn’t be used.

From now on, we will be discussing the learner who isn’t meeting expectations (LWIME). This doesn’t label, and describes their current behaviors, not their potential.
3/ Can we define LWIME? Per @JenniferSpicer4 & @gradydoctor, you need a measuring stick to say whether a learner is, or is not, meeting expectations.

Great tools are the #ACGME Core Competencies or #CanMEDS Framework. You can further break this down by specialty #milestones.
4/ Why is this important?

In order to identify BEHAVIOR for improvement, it is very important to be specific. These institutional measuring sticks help you focus your assessment AND your coaching.
5/ After you have defined the domain in which a learner isn’t meeting expectations, you need to clarify:
🔑 Cause (work vs. non-work issues)
🔑 Frequency (limited vs. recurrent/frequent)

This data will help you tailor your feedback.
6/ This is why the “ART of Feedback” is so helpful. It allows you to gather collateral information and perspective (regarding cause and frequency, etc.) from your learners to help shape your feedback.

7/ So, the tools needed to discuss an area that needs improvement are:
⭐️Behavior
⭐️Cause
⭐️Frequency

What if you can’t pinpoint the answer to any of these?

Talk the case over with a trusted, confidential colleague. You will likely end up describing the behaviors.
8/ If the area in which a learner isn’t meeting expectations is not listed in the competencies or milestones, then it is time to check yourself.

Are my expectations out of whack?
Is it just a personal attribute that annoys me?
Am I being biased (racist, sexist, ageist, etc.)?
9/ Again, find a trusted colleague to discuss if you are having a hard time here.
10/ Even if the expectation is on the list, #bias can still play a role. #Professionalism is a particularly sticky one as the “rules” of professionalism have historically been defined by white-cis-hetero male physicians (speaking as one).

CC: @PedsOtoDoc

pubmed.ncbi.nlm.nih.gov/32134778/
11/ Equipped with your three data points it is now time to deliver the feedback. When it is your turn to “tell”, make sure to do the following:
🔑Name the behavior
🔑Explain (using specific examples) the impact of the behavior
🔑Ask for the learner’s reflections
12/ Delivering feedback as close to the event (good or bad) is important, but for the LWIME, it is VITAL.

The sooner you 2 are on the same page about the work that needs to be done, the sooner you 2 can get to work!

Remember, NO SURPRISE FEEDBACK at the end of the rotation!
13/ After feedback has been delivered, team up to devise SMART goals. Use short intervals so that you can check in soon about progress. Sit down to discuss results:
🥳If goals achieved, celebrate (+/- make new goals)
🤔If goals not achieved, reevaluate goals and strategies
14/ Many colleagues and trainees are reticent to deliver tough feedback.

We should relish these opportunities as teachers.

A tough feedback convo can galvanize a relationship when trust is present & is just the beginning of a mutual journey towards improvement.
15/ Thanks again for joining us today! Any questions, comments, #Feedback, just reply to this tweet.

Follow @JenniferSpicer4 so you can learn about Soliciting Feedback during next #TweetorialTuesday.

Have a great week!

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More from @GStetsonMD

9 Mar
1/ Formative Feedback? Say whaaaat?

Hey #MedTwitter & #MedEd Friends!

We are the #MedEdTwagTeam back again for another #TweetorialTuesday!

Thanks for joining us!

Follow: @GStetsonMD, @JenniferSpicer4, & @MedEdTwagTeam to stay up to date. Image
2/ Today we are going to be breaking down #FormativeFeedback.

What it is, how we think about it, and how to implement it.

As always, any questions or thoughts, please reply to this thread. We LOVE it! Image
3/ So, what is #FormativeFeedback, you ask?

This is information that is given to a learner that enables them to make needed changes before the end of the course/rotation.

pubmed.ncbi.nlm.nih.gov/22730899/ Image
Read 13 tweets
2 Mar
1/ You've got feedback to give. But how to deliver it?

Hey #MedTwitter & #MedEd Friends!

We are the #MedEdTwagTeam, back again for another #TweetorialTuesday! 🙏 to all who follow, enjoy, and share!

Follow: @GStetsonMD, @JenniferSpicer4, & @MedEdTwagTeam to stay #UpToDate
2/ We have reached Week 4 in our #Feedback threads.

Last week, @JenniferSpicer4 taught us all about the components of effective feedback, including setting, timing, specificity, frequency, and more.

This week we will talk about the two main methods of feedback “delivery.”
3/ So the two main methods are a “download” and a “dialogue.” What do these terms mean?
Read 14 tweets
22 Sep 20
1/ 💭 Did I check the labs? I know they were fine yesterday. What should I say? 💭

As a supervisor, you need to make clear to your learners (1) the right answer is: “I forgot to check them”

And (2) your reaction will be: “No problem. Let’s check them now.”

#MedEd #MedTwitter
2/ Here is where we are in our journey through the #HierarchyOfTeachingSkills.

Remember that this first level of skills is all about #PsychologicalSafety.

Not judging your learners is key to this.

Find our previous threads @MedEdTwagTeam.
3/ I make sure I never judge my learners. But I DO evaluate them and hold them accountable.

To me, these are three different things.

Here is how I define these concepts 👇
Read 14 tweets
8 Sep 20
🙏 @ShreyaTrivediMD! Fascinating questions. My answers:
1. #Hesitations - Two things...
A. Already distracted by phone (email, texts, etc.). Will Twitter make it worse? Answer, yes. However, I try to limit my interactions to specific times, and turn off notifications.
B. I work for the Federal Gov. Outspoken for #Equity #Inclusion #HumanRights #HeForShe #BLM #LGBTQIA.

I worried about violations of #HatchAct.

However, can speak about issues, just not parties or candidates.

However, #45 doesn't care about Hatch Act. Should I?
2. My most meaningful collaboration in my career has come via #MedTwitter. @JenniferSpicer4 and I noticed similar ideas and content from each other, then set up 1 meeting, and @MedEdTwagTeam was born. We have never met in person, but have collaborated weekly for months now!
Read 4 tweets
8 Sep 20
1/ 💭 When should I show up? What if I answer a question wrong? Is my presentation too long? Where’s the bathroom? 💭

Sounds like a case of “New Rotation Jitters”

The Cure - Setting Expectations!

Literally, one of my favorite things 🤓

#MedEd #MedTwitter #MedEdTwagTeam Image
2/ Here is where we are in our journey through the #HierarchyOfTeachingSkills.

Remember that this first level of skills is all about creating #PsychologicalSafety.

If you want to see any of our previous threads, check out the @MedEdTwagTeam account. Image
3/ Setting clear and explicit expectations is a key teaching skill that will pay numerous dividends.

And like much of teaching, there is an art and a science. Image
Read 19 tweets
26 Aug 20
1/ Bias in Medicine – A 🧵

This week I was able to participate in a #BiasInMedicine curriculum @UCSFMedicine. Below are some of my favorite (paraphrased) quotes and insights.

CC: @gradydoctor @dereckwpaul @jbullockruns @ChaseTMAnderson @_HarryPaul_ @FutureDocs @Bob_Wachter
2/ Black Female MD:

“Me being present everyday is me advocating. Just being in this space is me speaking up.”

“Some identities that we have are out in the open. Others are hidden, such as certain disabilities. These can be sources of bias. This is important to remember.”
3/ Latinx Female Med Student:

“Don’t ever call the medical student ‘the medical student’”

“There are times when the #HierarchyInMedicine makes sense…graduated responsibility to keep patients safe. That doesn’t mean it has to translate into all aspects of training.”
Read 10 tweets

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