Learning Objectives
By the end of this online module, you will be able to:
1. Describe the importance of giving positive and constructive feedback to students during clinical externships.
2. Apply this knowledge to evaluate a clinical scenario in which a student does not respond as you might expect to constructive feedback.
3. Use other resources, materials, and readings provided in self-study to further develop your knowledge and skills regarding feedback.
Case Study
You are a Clinical Educator and have previously supervised two students. You are supervising a first-year student on their first clinical externship, which is five weeks long. In your clinic, you have a very busy schedule, sometimes seeing up to eight clients per day. On the first day, you and the student only had 30 minutes to have an initial conversation about expectations for the placement.
The first week starts off well, with the student observing you working with your clients, appears to build rapport quite easily with the clients, and asks you knowledgeable theoretical and clinical questions. During the second week, the student begins to plan and complete a few sessions on their own. After each session, you only have five minutes to give the student verbal feedback, before seeing the next client. With one particular therapy session, you begin by telling the student what they did well and then you provide some constructive feedback about how the student can improve and ideas to try for the next session with that client. Your student responds with a defensive tone of voice, body language, and a reactive comment: “I disagree with you.”
Giving and Receiving Feedback Online Module
For the next section, please go to https://owl.uwo.ca/portal/site/!pep. The University of Western Ontario has developed a Preceptor Education Program (PEP) for Health Professionals and students. PEP consists of eight learning modules and can be used by any health care discipline.
PEP uses Western’s OWL learning management system and you need to have either a Western account or an OWL account to access it. Click on the “Request Account” link and follow the directions to request an OWL account. This will take approximately five minutes.
After you have an OWL account, you can access any of the PEP modules at any time. For assistance with creating a login, you can also contact OWL at https://owl.uwo.ca/portal/site/!gateway/page/f2c79008-1fe0-438c-ab6a-b2bf6fde27d1.
To Think About
To help you reflect on the questions below, complete the PEP online module: “Giving and Receiving Feedback.” The module will take approximately 30 minutes to complete.
1. What do you think your initial reaction would be in this situation?
2. How do you think you would respond to the student?
It can be difficult to know how to respond in this situation and to respond non-defensively (“Being on the Receiving End” submodule). You may have to take a few seconds to stop your initiation reaction: to allow your brain time to process the situation, to stop a dismissive facial expression/reactive comment and to remind yourself to stay calm. Modeling this behavior will be beneficial to your student, especially when giving and receiving future constructive feedback. Completing the “Learning Activity” submodule may help you in understanding yourself better in how you prefer to receive feedback.
3. You decide that because you did not have adequate time for orientation during the first week of the placement, you will devote two hours this week to focus on this with the student. What will you discuss with the student? (“Feedback in Practice Placements” submodule).
4. What three steps can you follow to help ensure your feedback is effective? (“Tips for Providing Effective Feedback” submodule).
5. Because this student is a Level 1 (first-time) student, how should you give feedback? (“Adjusting Feedback to the Experience Level of the Student” submodule).
6. In this situation, what would be a wrong way to give feedback to the student? (“The Wrong and Right Way to Give Feedback” submodule). Write what you think you would say.
7. In this situation, what would be a right way to give feedback to the student? (“The Wrong and Right Way to Give Feedback” submodule). Write what you think you would say.
You may feel you want to avoid conflict in this situation because you feel that criticism will affect your relationship with the student. Although it will be difficult to give constructive feedback in this specific scenario, students appreciate open and honest communication from their Clinical Educators. It will be in the student’s and your best interest to talk about the student’s reaction right away, in order to help the student with receiving future constructive feedback and ultimately, to continue to develop their clinical and professional skills during the remainder of the placement. You may want to start the conversation with your observations: “Let’s sit down for a moment and talk about this. I noticed you were defensive when I gave you some feedback. Tell me what you are feeling/why you think you reacted this way?”
8. What are some strategies that could be put in place at this point in the placement to help manage the student’s expectations about feedback?
Hint: Refer to “General Feedback Strategies” on page 36 of the Speech-Language Pathology Externship Handbook and also provided here for your reference:
General Feedback Strategies
• Allow space for response and interaction in all feedback meetings
• Where possible, take a few minutes to do a general check-in with the student. This will help gauge where the student “is at.” This in turn will facilitate the delivery of meaningful feedback that can be processed by the student in that moment
• Consider other sources of feedback. Another peer or a client can be useful sources.
• Consider the methods of feedback that you will employ: verbal, written, video, audio, direct or indirect
• Try to limit your feedback to one or two points per session. This makes the feedback and ensuing suggestion for change more actionable on the part of the student
• Deliberately seek the student’s own perceptions of their performance
• Ensure that feedback includes discussion around how the student can apply the feedback to practice
• Always include positive feedback: What is something that went well or that you were impressed by?
• Remember you are always working at developing your student’s clinical reasoning skills. If a students does not know something that you are asking them, resist the temptation to give the answer. Such gaps in knowledge can be homework and can be revisited the next day
What are some other strategies that you think would be beneficial for this particular student at this point? It might be a good idea to also ask the student if they can think of any strategies that they think might be useful.
9. Should you contact the student’s Clinical Coordinator at the School of Audiology and Speech Sciences?
We always want to hear from Clinical Educators, whether it be challenges or successes. The Clinical Coordinators provide ongoing support and mentorship to both the Clinical Educator and the student throughout the entire placement. If there are any concerns about the placement or the student, contact the Clinical Coordinator as soon as you are concerned.
10. Do you have any other thoughts or comments about how you would handle this particular situation?
Additional Resources
The list below provides an example of a Feedback Conversation between a Clinical Educator and Student (Cantillon & Sargeant, 2008), which can be found on page 35 of the Speech-Language Pathology Externship Handbook. In this model, the student shares first, having had time to reflect post-session. The CE responds and expands on what the student has shared, delving deeper if necessary. Following this, the CE provides their own specific feedback to the student. If it suggested that the student make notes of this feedback, and prior to creating an action plan, the student reflects back their interpretation of what the CE has shared. This solidifies mutual understanding and limits the risk of miscommunication. The action plan is then created and agreed upon between the CE and student.
This facilitates the development of the student’s self-evaluation skills and promotes reflective learning
Student Role:
NOTE: The student should have some time to reflect before the feedback session.
Student should begin the discussion by self-evaluating their performance. This can be written and/or verbal.
Structured questions can facilitate this process for students and provide a good starting point for ensuing discussion (See Student Post-Session Self-Evaluation form on page 61 of the SLP Externship Handbook):
1. What went well that you would do again? Why?
2. What observations did you make throughout the session? Based on these observations, would you make any adaptations to your original session plan?
3. What would you like to change? How will this change improve the outcome?
4. What would you not do again and why?
Clinical Educator Role:
The Clinical Educator can ask various probing questions (as outlined above) Other examples include:
• How did you feel during the session?
• How do you think the client felt? Why do they think that?
• What did you learn from the session? Any critical learning opportunities?
Student Role:
The student will respond accordingly.
Clinical Educator Role:
Direct feedback should be:
1. Constructive
2. Objective
3. Specific
4. Timely
Feedback can be verbal or written
Did the student accurately interpret the feedback given? Ask the student to summarize the feedback back to you.
See Feedback Interpretation Form on page 63 of the SLP Externship Handbook
Clinical Educator Role:
Suggestions for future sessions can be discussed.
Student Role:
The student can ask further questions here.
The student should repeat the feedback that they have interpreted to ensure accuracy. See Feedback Interpretation Form.
Clinical Educator Role:
This should be initiated by the student and agreed upon jointly.
Student Role:
The student should have a clear plan of what to work on during the next session.
Reference:
Cantillon, P. & Sargeant, J., Nov 2008. Giving feedback in clinical settings. British Medical Journal, November 2008, Vol 337; 1292-1294.
Additional Readings
For continued self-study about feedback, the following articles are recommended:
Clynes, M.P. & Raftery, S.E.C. (2008). Feedback: An essential element of student learning in clinical practice. Nurse Education in Practice, 8, 405-411.
Heckman-Stone, C. (2004). Trainee preferences for feedback and evaluation in clinical supervision. The Clinical Supervisor, 22:1, 21-33.
Join the Conversation:
What feedback strategies do you employ? Do you have examples that you would be willing to share?
Contact Us: If you have questions or comments about this learning module, please email Cheryl McGee at cheryl.mcgee@audiospeech.ubc.ca.