Jennifer Spicer, MD, MPH Profile picture
May 31, 2022 β€’ 17 tweets β€’ 8 min read β€’ Read on X
1/ "Do you have a second to chat?"

(i.e., The phrase that results in almost a reflex cringe 😳...)

We all want feedback,
but we dread it at the same time.

How can we deliver better feedback?

Check out this week's thread for some tips! Image
2/ This week we will discuss giving feedback in the inpatient setting with a focus on integrating it into daily clinical care.

For more detailed threads on feedback, check out our prior 11-week series on the topic:
twitter.com/i/events/13632… Image
3/ For feedback to be well-received, there needs to be a culture of trust and respect between you and your learner(s).

Seriously, this is THE most important part.

Check out @GStetsonMD's prior thread on the topic:
4/ This paper in @AcadMedJournal on the educational alliance describes the importance of the supervisor-trainee relationship in feedback. Image
5/ So how can we create an effective educational alliance?

Well, I think it's helpful to use a coaching framework to rethink our feedback delivery.

See my schema below, which provides a more familiar example of how coaching is used in a sport, like tennis. Image
6/ But we should teach feedback in medicine in the same way.

Because our goal it to improve our learners' performance, no matter what level they are at when they join us.

So let's be a coach!

Right, @ETSshow? #MedLasso
7/ Step 1: Goal Setting

To do this, I ask each learner to identify 2 things that they want to work on during their time with me.

I help them refine their goals to align with core competencies & include any areas that I have identified as an area of need. Image
8/ Here's an example of how I would negotiate goal-setting with a learner who wants to work on "efficiency" which is one of the most common goals that I hear from learners.

Notice that I still keep the goal related to their interest. I just help them refine it. Image
9/ Now, you may be wondering what to do if you have a learner who isn't meeting expectations and doesn't identify a goal that aligns with difficult feedback you need to give.

Thankfully @GStetsonMD has already written a thread specifically on that topic!

10/ Step 2: Observation

There are SO MANY opportunities for us to observe learners during the day (see below).

For the efficiency example that I've provided, it would be important to actually watch a learner work up a new patient. Use this time to staff a new patient early! Image
11/ Step 3: Evaluation

The term "evaluation" is loaded.

But the idea is that we are just communicating to the learner what we have observed.

We can give indirect or direct feedback. Both have their place. But most of our feedback should be on the right side of this spectrum. Image
12/ And it's important that this feedback occurs FREQUENTLY, not JUST at the end of the rotation. Because the feedback is what helps them improve.
13/ Ex: If I'm giving feedback on efficiency of their notes, then I should give them daily tips on how to improve their efficiency - new SmartPhrases to add, options for making the notes more succinct, etc.

Then, at the end of the rotation, I can reinforce changes they've made.
14/ Step 4: Action Plan

Then, at the end, it's important for us to co-formulate an action plan for continued growth with the learner.
Notice that this should be CO-CREATED. I often ask learners for their ideas first. Then I build on them with my own ideas.
15/ You'll notice that we've already started creating an action plan in our example since we've provided some efficiency tips. So the action plan is being enacted during the rotation.

But at the end, I try to create an action plan for continued improvement (or something new!).
16/ So, in summary, use coaching to help you deliver better feedback.

It allows you to engage in continual feedback throughout the rotation. And, because it's feedback on a learner-selected goal, they will be excited to have those feedback conversations! Image
17/ Join us next Tuesday when @YihanYangMD discusses how to teach with family meetings.

In the meantime, follow @MedEdTwagTeam, @GStetsonMD, & @ChrisDJacksonMD so that you don't miss any content! Image

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More from @JenniferSpicer4

Mar 17, 2023
Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

⁦@gradydoctor⁩ Image
Do you want a 4-step process for questions to ask when you get a page next year when you’re alone on nightfloat or ICU call?

Check out this framework! Image
And now, do you wanna remember who the heck to order DEXA scans for in clinic?

Thankfully Miko De Bruyn comes to the rescue. Image
Read 16 tweets
Mar 7, 2023
1/ You're seeing a new consult with your team, and you want to teach the primary team too.

But WHEN is the best time to teach them?

On the phone?
At the bedside?
In their team room?

And in the morning?
Or maybe the afternoon?

This week: Image
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.



But when should we teach them?

Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.

With one caveat.

Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.

But let's explore some general principles to consider.
Read 15 tweets
Feb 21, 2023
1/ You're finishing your last consult of the day.

It's late.
And it's been a long day.

You intended to find the primary team to teach them, but you have a million other things on your "to do" list.

Here are 8 reasons why you should still find time to teach the primary team. Image
2/ Reason #1: They want to learn

The primary team called with a question.
They are invested in the answer.

It's all about finding out what they want to know and targeting your teaching accordingly.
3/ Reason #2: It empowers them

Often the primary team has an idea of what to do but wants reinforcement that their plan is correct.

Teach them general rules that they can re-use. Image
Read 12 tweets
Jan 31, 2023
1/ Your team just saw a patient with syphilis, and you're ready to teach, but:

Resident #1: on week 2 of their rotation
πŸ‘‰ Has already seen 2 patients w/ syphilis

Resident #2: started today
πŸ‘‰ Hasn't seen a single patient with syphilis

What should you do now? Image
2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons. Image
3/ As @VarunPhadke2 previously pointed out, all learners on the team are usually not present all day, every day for the entire time we are on clinical services.

Image
Read 16 tweets
Jan 24, 2023
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.

Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow

How can you possibly provide valuable teaching to all of them?

This week: Multi-level teaching Image
2/ Teaching multi-level learners is hard.

Their range in baseline knowledge means a single teaching point is often not effective for everyone.

So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.

This is one πŸ—οΈ for effective multi-level teaching.

Know what materials is RELEVANT and INTERESTING for each learner level.

Read 14 tweets
Jan 10, 2023
1/ *Re-consult πŸ“ž*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🀦 I feel you... We'll see the patient again. Image
2/ You wonder...

πŸ’­ What tick serologies were we referring to?
πŸ’­ What antibiotics were we wanting to start?
πŸ’­ And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?
3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

Read 15 tweets

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