II.

Delivering effective
feedback

醫學 教育 部 林 季緯 主任 1 0 4 .7 .2 7
回饋
• 回饋是重要的學習過程之一

• 回饋有強烈的目標導向
Feedback vs. Evaluation
• Feedback:
• 持續提供（ on-going provision ）學員表現狀況的訊息，以導引
並改善（ guide and improve ）未來的努力方向

• Evaluation:
• 對於先前表現的評判（ judgment ）
Everyone Seeks Feedback…
• And if we don’t get it, we make assumptions and attributions!
• Self-assessment is notoriously unreliable
• 沒有即時有效的回饋，學員可能會錯誤地減少某些被期待的行為
（ extinguish desirable behaviors ） ，反而保留了一些不受歡迎也
不恰當的行為（ entrench undesirable ones ）

• Medical teachers don’t deliver as much feedback as they think…

Are International Medical Students Different?

• YES
• And NO
What Have Been Your Experiences
Delivering Feedback to IMS?
• 對他們進行回饋有哪些和台灣學生類似的地方？
• 有哪些不一樣的地方？
• 在你的工作場域中，存在哪些阻礙（ barriers ）或優勢
（ enablers ） ?
How IMGs May Be Different…
• 巨大的文化差異 Tremendous cultural diversity
• 老師的小批評可能被學生解讀為犯了嚴重錯誤 Critique may be
viewed as serious error
• 師生權力關係的解讀可能有差異 Power dynamics may be different
• 不願意暴露弱點 Difficulty in exposing weakness
• 失敗的後果 Consequences of failure
• 年紀較大 Older than other learners
• 家庭環境與經濟壓力 Family circumstances and financial burdens
• 對新文化與新環境的適應調整 Adjustment to new culture and
language
Commonly Reported Issues
• Medical knowledge
• Clinical skills
• Communication skills
• Language skills

• But these are HIGHLY variable between individuals!

Think of Times When You, as a Learner,
Have Received Feedback…

• When it was helpful – what was it that made it so?

• When it was not useful – why was that?
Steps in Delivering Feedback

Build an environment of trust and support

• 以身作則，尋求回饋或給予回饋 (asking for, and using,
feedback)
• 以身作則，展現對知識技能不足的包容性 (an acceptance of
personal gaps in knowledge and skill)
• 傳達有的時候犯錯是無可避免 (mistakes are inevitable) 的認知
• 主動鼓勵學員尋求建議或協助
Steps in Delivering Feedback
Plan ahead and negotiate
• 回饋不應該僅是意外的驚喜（ come as a surprise ）
• 澄清回饋 feedback (coaching) 和評估 evaluation (judgment) 的不同
• 尋求更多觀察的機會（ opportunities to observe ）
Steps in Delivering Feedback

Elicit learner self-assessment

• 有助於了解學員的想法
• 可以決定回饋的重點
• 有助於衡量回饋的複雜度
• 學員通常會完成大部分的工作！
• 有時會遇到學生不熟悉或不情願的情況
Steps in Delivering Feedback
Choose appropriate timing and setting
• 越及時越好 （ As close in time as possible ）
• 及時的回饋（ quickie feedback ） ，如有必要再加上稍後詳細的
討論（ later discussion if necessary ）
• 注意隱私
• 要關注學員情緒
Steps in Delivering Feedback
Focus on the positive, not just the negative
• 老師常會為了快速矯正錯誤（ quicker to correct ）而忽略鼓勵正
向行為（ reinforce ）
• 引發正面的情緒（ positive feelings ）有助於學員樂意進行改變
• 用正面的詞彙 positive terms 框架住有用的訊息
• 指出其行為帶來的影響（ impact of behavior ）
Steps in Delivering Feedback
Select specific, changeable behaviors
• 老師常會不知不覺講太多學習的重點 - 選其中兩三個最重要的就
好了！
• 描述觀察到的行為（ describe observations ） - 要具專一性（ be
specific ）
• 選擇學員能改的部份進行回饋！
• 著重在先前有被辨識出的學習需求（ learning needs ）
Steps in Delivering Feedback
Use a feedback model (sandwich or grid)
• 系統化的方式（ systematic approaches ）是有用的
• 三明治法（ PNP sandwich ）
• highlight a positive aspect, then one to be improved, then another positive
• 回饋方格 Feedback grid
• adapted from the Bayer Institute
• behaviors to continue, or do more of; behaviors to start doing; behavior to stop or
do less of; future behaviors
Compliment

Criticism

Compliment
Feedback Grid
Continue… Start, or do more…
對有用的行為表現加以回饋，要專 找出那些學員知道、應該要做，
一，且描述其影響性，強調有哪些 或者是應該要多做一些的行為。
事是以後我們還期待看到的。 Identify behavior the student knows how to
Comment on aspects of performance that were do and should do, or do more often.
effective. Be specific and describe impact.
Highlight things you would like to see done in
the future.

Consider… Stop, or do less…

強調一個可協助學員成長的重點， 指出有哪些行為是無用甚至是有
一個學員在未來可以做得到的挑 傷害性的，要有專一性，且指出
戰。 其潛在影響。
Highlight a point of growth for the student, a Point out actions that were not helpful, or
“doable” challenge for future interactions. could be harmful. Be specific and indicate
potential impact.
Steps in Delivering Feedback
Include follow-up plans
• 新的行為需要反覆加強（ reinforcement ）
• 落實執行絕非易事
• 有策略地付諸實現 （ putting it into practice ）
• 適時追蹤有助於加強改變成效 （ reinforce change ）

• 並且要凸顯其成功的改變（ highlights successes ）

擬定改善計畫＆輔導追蹤的影響
• Creation of an action plan leads to change
• Answers the “Where to next?” question
• Feedback alone does not cause change, it is the goals that people set
in response to feedback (Locke et al, 1990)

• Mentoring increases the likelihood of change following

feedback
回饋方式
Accurate, specific, concrete
v.s.
Vague, generalized, impression

回饋的面向
認知面向 Cognitive domain: knowledge gap
情感面向 Affective domain: attitude issues
技能面向 Psychomotor skills
In Summary…
• 建立互信的環境 Build an environment of trust
• 事前規劃有效溝通 Plan ahead and negotiate
• 引導自我評估 Elicit self-assessment
• 決定適當的時間地點 Determine appropriate setting and timing
• 強調正向行為 Focus on the positive
• 選擇具專一性且可被改變的行為 Select specific changeable behaviors
• 使用有效的回饋模式 Use a feedback model
• 包括追蹤計畫 Include follow-up plans
Observing Learners.. What Are Your
Opportunities and Strategies?
In the same room:
• Keep quiet
• Avoid eye contact with the patient
• Turn to the learner if addressed by the patient

Use natural opportunities:

• Listen to phone conversations
• Hallway discussions

Briefly observe many different parts of encounters

Practice Makes Perfect!