The rules

“Dear Editor, I read with interest your reworking of my manuscript. Firstly here are a few things that you did well: you checked the spelling thoroughly and you did improve the grammar. Here's what you could have done better: it would have been better if you hadn't completely changed the tone and style and meaning of my sentences. Yours etc.”

Pendleton's rules are rules that help trainers give balanced feedback to trainees.¹ The idea is that, when giving feedback, learners and teachers should concentrate on the positive first and then say what they thought could have been done better. If you've done an advanced cardiac life support course in Britain then you'll be familiar with the rules. In the past many trainers were thought to be too destructive in their criticisms, and Pendleton's rules are an attempt to correct this.

But the rules do have their critics. Many say that they add an Alice in Wonderland air to training. I've had a few complaints as an editor and as a clinician, but none of them ever read like the above letter. So why do we encourage doctors to give and receive feedback in a way that they will never experience in real life? It can also be difficult to think of positive things to say to trainees who are still in the low foothills of the learning curve or who, worse still, have turned up to courses without having done any preparatory work. How do you then “accentuate the positive”? Do you say, “Well, at least you turned up”? Perhaps the most annoying thing about the rules is the insistence of some training providers that you must follow them—regardless of the learning style of the learners or the teaching style of the teacher.

Is there an alternative? Silverman et al have described a new way of giving feedback—called agenda-led, outcomes based analysis.² In this method you 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 get the trainer and eventually the whole group involved. Feedback should be descriptive rather than judgmental and should also be balanced and objective.

If you are involved in teaching and learning then you may be interested in finding out more about these concepts. At BMJ Learning we are building up a resource of modules on learning and teaching. You can find out how to run a course, give a lecture, or even give feedback. You can give your views also. If you disagree with Pendleton's rules or with Silverman's ones or would even prefer a return to a 19th century “gloves off” approach to feedback then we are delighted to hear your views and to encourage debate.