In academic emergency medicine (EM), we coach and train residents throughout clinical shifts and beyond. Feedback is crucial to professional development and should be timely, specific, based on direct observation, and actionable. Ideally, it is delivered in a space that feels safe and at a time when the learner is receptive. Preferred EM feedback models are adaptable given the unpredictable nature of the emergency department (ED). 1 The Self‐Assessment Feedback Encouragement Direction (SFED) tool is a competency based feedback model first described by Bell in 2007. 2 SFED incorporates portions from other feedback models such as Ask–Tell–Ask and R2C2 and is unique as it has protected time to address learner self‐assessment and includes encouragement. 3 Its succinct nature while still incorporating affirming and constructive feedback and self‐reflection makes SFED ideal for use in the ED. Additionally, it can be adjusted for different learner types and training levels, growing with the graduated responsibilities of the learner from mentoring (this is what I would do) to coaching (what do you think you should do). Below is the EM adaptation of the four step process for learner‐centered feedback as well as key microskills and educator prompts to help use this model effectively.
SFED model as applied in academic EM
Self‐assessment/ask
Begin the conversation in a private space by asking the learner for their self‐assessment of the situation and then allow them time to reflect. When the learner is ready to provide their self‐reflection, allow them to speak first, unbiased by your opinions. While actively listening, prompt them for positives. The use of self‐assessment establishes that this will be a bidirectional dialogue rather than a lecture. It sets a foundation, empowers the learner to share their impressions (creating some psychological safety and a sense of autonomy), and provides the teacher with an understanding of the learner's insight into their performance as well as an idea of the lens through which the learner will view this particular feedback. This all lays the groundwork for the teacher to help the learner develop their own improvement plan. Close this section of SFED by asking the learner if they are open and ready to receive feedback on the situation under discussion.
Microskills: Reflection, active listening, self‐assessment, coaching, bidirectional feedback.
Educator prompt: “Tell me about how that went from your perspective.”
Feedback/facts
While being descriptive and focused on the performance, in a nonjudgmental manner, share with the learner what you observed. For learners who are not receptive to feedback, it can help to return to the S in SFED and allow self‐reflection while sharing specific feedback regarding the observed behavior and areas for improvement. Timeliness is important to help the learner be receptive to the feedback. In the ED, we have the opportunity for direct observation through bedside teaching, resuscitation cases, and procedural supervision. 4 The faculty member is able to share and praise directly visualized actions as well as give constructive feedback, supported by fact, on areas that require improvement. Finding a private space for constructive feedback that is free of distractions is crucial to maintain a supportive and psychologically safe environment while encouraging a growth mindset 5
Microskills: Open‐ended, higher‐order questions; facilitated active listening; direct observation; incorporation of reinforcing and corrective feedback; timeliness.
Educator prompt: “This is what I saw you do well …” “This is an area that I saw you could improve on. Is it okay if we talk about it?”
Encouragement
Use supportive language that leads with empathy and understanding to show confidence in the learner. Lead with empathy by focusing on listening to the learner, taking cues from them on how/when to offer guidance for improvement and growth. The learner should feel supported and have a shared goal with the teacher. Be cognizant to maintain a supportive tone and language as we learn better when we feel safe. The zone of proximal development is the difference between the current and potential ability of the learner. 6 Ideally the learner should be stretched to grow but not so far that they feel overwhelmed. Help the learner by building an educational scaffolding to bridge them to the desired goal.
Microskills: Supportive language, scaffolding, building a path together, growth mindset, zone of proximal development.
Educator prompt: “I have confidence that with effort you will master this procedure.” “By practicing this technique, you can work on improving your interviewing and physical exam skills.”
Direction, ask, and agree
Ask the learner about their improvement goals while incorporating self‐reflection and then feedback. With the learner driving the conversation, give specific actionable suggestions for improvement. This is the coaching stage, and one of the most important challenges the learner faces in reaching their potential. Here, we aim to create an interactive partnership with shared goals. Using appreciative inquiry, 7 prompt the learner by asking them to identify a clear outcome focus based on their internal motivation and shared goals. The faculty member can then guide the learner to recognize their strengths and frame any current weaknesses into strengths to be developed. This act of reframing produces significant change in the learner's self‐esteem that also internally motivates the learner to make further attempts to succeed.
Microskills: Reflection and active listening, appreciative inquiry, coaching, motivational interviewing.
Educator prompt: “I'm curious, given our prior discussion, what do you think you should work on? How do you think we should go about achieving that?”
Bottom line
The SFED model is an efficient four‐step strategy to give effective feedback. It is well suited for the ED because it can be easily adapted to the variable pace, diverse clinical scenarios, learner types, and performances observed.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Husain A, Stehman CR, Thompson M, Corbo S, Natesan S. Using the Self‐Assessment Feedback Encouragement Direction (SFED) model of feedback/coaching model in academic emergency medicine. AEM Educ Train. 2024;8:e10968. doi: 10.1002/aet2.10968
Supervising Editor: Esther Chen
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