145optimal for improvement. Feedback is formative; it helps the learner achieve their
goals and looks forward to continued improvement. This is best done with neutral
descriptions about what occurred and what could be improved. Evaluations are
summative and look backward, reflecting the past performance and providing
judgment about how well a learner compared to a standard or their peers [ 23 ]. An
evaluation of a poor performance, although informative, will not be nearly as help-
ful as a formative feedback session that provides guidance on how to perform bet-
ter next time.
Within this general framework, several specific characteristics of effective feed-
back have been drawn from medical education and other fields such as personnel
management and validated for use by medical educators [ 23 , 24 ]. The characteris-
tics summarized in Fig. 8.1 can be broadly divided into those apply to setting up the
environment for feedback and specific techniques for the feedback itself and can be
applied to both positive reinforcement and negative constructive feedback. For the
context of this textbook, we will focus on feedback from the perspective of the edu-
cator for two reasons: (1) this book is primarily written for educators, and (2) in
medical education in general and in the operating room in particular, the educator or
attending faculty member has tremendous influence on establishing the environ-
ment and leading educational objectives. In this context, directing our efforts toward
teachers will likely offer important gains in educational outcomes and may be a
necessary prerequisite before turning our attention to learners [ 27 ].
Because we are dealing with human learners, the complex dynamics of emotions
and interpersonal relationships have a tremendous impact on the success or failure
of any educational endeavor including operative performance feedback with its
high-stress, high-stakes decisions and close relationship with the faculty. Humans
have a natural defensive mechanism against negative emotions defined by Gilbert
Setting up the feedback environment
Based on direct first-hand observation
Timely: as soon as possible after the observed task, not more than 72 hours
Self-directed by the learner
Respectful unthreatening climate
Non-judgmental
Based on well defined pre-negotiated goals
Feedback techniques
- • • • • •
Eliciting thoughts and feelings before giving feedback
Focusing on behaviors not personality
Basing feedback on specific observed facts
Providing the correct amount of feedback (not too much or too little)
Providing specific suggestions for improvement
Works with the learner to establish an action plan for continued developmentFig. 8.1 Characteristics of effective feedback
8 Teaching in the Operating Room