Table 1.
Summary of guidelines. For the individual clinical supervisor giving feedback
| Do’s for the process of feedback | Strength of recommendation | |
| Guideline 1. | Do realize that feedback is not just one person providing information to another to help them improve. Feedback is part of a social interaction influenced by culture, values, expectations, personal histories, relationships, and power. Do treat feedback as a conversation rather than as a commodity | Strong |
| Guideline 2. | Do recognize that trainees must perceive feedback as credible in order for it to be influential. Credible feedback is well-informed, typically by direct observation of the task or event, and it comes from a trustworthy source. Make sure that you as supervisor set a good example as a credible role model | Moderate |
| Guideline 3. | Decide the timing of feedback depending on the competence level of the trainee and on the complexity of the task | Moderate |
| Guideline 4. | Do encourage trainees to look for feedback and use it to enhance their performance | Moderate |
| Do’s for the content of feedback | ||
| Guideline 5. | Do tailor bespoke feedback to the individual trainee. The trainee might benefit from: | Strong |
| – Reinforcement of key points done well | ||
| – Identification of key points which might have been done better or omissions | ||
| – Working out strategies for improving the quality of their work | ||
| – An increased self-awareness | ||
| Guideline 6. | Do give specific feedback, focused on how the task was done and how that type of task should/might be done | Strong |
| Guideline 7. | Do make sure to indicate whether feedback is about necessary improvement for minimally acceptable performance or whether it is a reflection on possible variations to build upon adequate performance | Tentative |
| Consider offering grades as an element of formative feedback if it seems that receiving grades will enhance the seeking of strategies for improvement. Conversely, avoid giving grades to trainees who you suspect will stop trying to learn if they get a good enough grade and to those who will give up if they get a poor grade | ||
| Guideline 8. | Do ensure that feedback is actionable, enabling the trainee to construct strategies for improvement. After discussing the trainee’s performance of a task, provide some guidance or ‘scaffolding’ to enable them to step beyond their current competence | Strong |
| Guideline 9. | Do attend to trainee motivation when discussing strategies for improvement | Moderate |
| Guideline 10. | Regardless of the specific approach to feedback that is used, do engage the trainee in a reflective conversation that marries their self-assessment with your observations and elaborations | Tentative |
| Several approaches have been described in the literature (sandwich, Pendleton, reflective feedback conversation, agenda-led outcome-based analysis, feedforward), but no single approach has been established to be the most effective. Rather, the likely best approach varies according to the learner, the teacher-learner relationship, and the context | ||
| Don’ts | ||
| Guideline 11. | Don’t assume that a single approach to feedback will be effective with all trainees or in all circumstances. As the players and the contexts change, so too does the most useful approach to feedback. Don't assume: | Moderate |
| – You know what a trainee wants to learn | ||
| – You know why a trainee is struggling | ||
| – You know if or why a trainee wants feedback | ||
| – You know what information a trainee takes out of a situation or feedback conversation | ||
| Guideline 12. | Don’t provide feedback without follow-up. Trainees are unlikely to be influenced by feedback that is not followed by an opportunity for them to demonstrate improving performance | Moderate |
| Guideline 13. | Don’t provide feedback that is poorly informed (or is based on hearsay); doing so diminishes the value that trainees assign to feedback in general | Moderate |
| Guideline 14. | Don’t underestimate the emotional impact of feedback that is perceived as negative. Emotional distress may be a barrier to acceptance and use of feedback | Moderate |
| Guideline 15. | Don’t give grades without explaining the criteria for allocation of grades and providing strategies for improvement | Moderate |
| Don’t knows | ||
| Guideline 16. | What determines the credibility of feedback? | |
| Guideline 17. | How much is the right amount of content when giving feedback? | |
| Guideline 18. | What determines the ‘open and safe interaction’ in the feedback conversation? | |
| Guideline 19. | What influences the trainee’s response? (constructive or destructive outcomes) | |
| Guideline 20. | Is overt comparison with peers—when made by the supervisor—helpful to the trainee? Indeed, is overt comparison with required performance standards helpful? | |
| Guideline 21. | Does a written summary of the feedback discussion enhance learning? | |
| (what elements of learning culture support the exchange of meaningful feedback, and what elements constrain it?) | ||
| Do’s | Strength of recommendation | |
| Guideline 22. | Do have a systems approach, building feedback into the learning processes | Moderate |
| Guideline 23. | Do support the development of longitudinal, trusting supervisor-trainee relationships in medical training; influential feedback thrives in the context of trusting relationships | Moderate |
| Guideline 24. | Do use video review with feedback as a component of training | Tentative |
| Guideline 25. | Do promote communities of practice in clinical workplaces in which feedback is routine, regular and valued | Moderate |
| Guideline 26. | Make sure that those who have a formal role in a workplace’s educational system are aware of that role and understand what learners’ educational objectives should be | Moderate |
| Guideline 27. | Make sure that the team give feedback regularly, reflect on the practice of giving feedback, and follow refresher courses to maintain and improve competency in providing feedback | Moderate |
| Don’ts | ||
| Guideline 28. | Don’t rely exclusively on faculty development to improve the effectiveness of feedback. | Moderate |
| Guideline 29. | Don’t allow formal assessments of clinical skills, such as the mini-CEX, to be completed without observation and feedback | Moderate |
| Don’t knows | ||
| Guideline 30. | What are the vital components that ensure a constructive system of workplace learning that caters to trainees, workers, and the educational system? How can the institution nourish a climate which encourages the provision and seeking of feedback? | |
| Guideline 31. | Is it most effective to give feedback to individuals alone or in a group setting? | |
| Guideline 32. | Does the use of formative assessment outcomes for summative purposes (such as having supervisors provide formative feedback that at the end of a rotation is also used for a summative assessment) corrupt a well-intentioned educational system? | |