Observing And Giving Constructive Feedback

In late 2009 I was asked by a work colleague to observe her teaching about Deliberate Self Harm. This presentation was organised as part of a staff Continuous Professional Development programme. My colleague was enrolled on the PGCert Med Ed course and was planning how to complete her assignments – we agreed a reciprocal arrangement, as I was aware I would be completing the same assignment in due course and I observed my colleague teaching a group of professionals and provided feedback afterwards.

The teaching session was for one hour and was attended by just over 20 members of staff from our department, ranging from trainees to senior clinicians, nurses, psychologists and doctors with whom I and my colleague work on a daily basis. My colleague used a PowerPoint presentation which included a simple quiz which acted as an ice breaker and she presented for just over 45 minutes allowing 15 minutes for questions. I considered that the duration of the presentation may be too long and the longer it lasted, the more likely the audience’s attention would lapse, which has been noted previously by Johnstone who described lapses of attention increasing in frequency as a lecture proceeds (Johnstone and Percival, 1976). I was aware that this audience would have some preceding knowledge and understanding of the topic of Deliberate Self Harm, due to their different clinical backgrounds, but that this would be variable which I thought might be challenging when deciding the length and content of the presentation. The level of interest the content would offer an individual would be more likely to maintain their attention and also improve their recall of the information (Wilson and Korn, 2007).

I had very little time to prepare for the observation, but I wanted it to go well, to not be just an “exercise” but to also have some value for my colleague. I was not provided with a framework or directed by my colleague to use a particular structure or format for the observation and feedback. I was unsure what format to use in noting the observation, but I have had experience before of providing others with feedback within my work. With this in mind, at the beginning of the session, I quickly drew up a structure to make notes, which would make it easier for me to provide the feedback. I decided to structure this loosely around Pendleton’s Rules (Pendleton et al 1984) as this was a process I was familiar with. I identified four key themes, including observation of the environment and content, observation of the teacher, observations of the audience and the interaction between them and the teacher. I made notes of what I felt had gone well and what could have been done differently, under the four key themes.

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The feedback session took about 20 minutes. We covered each of the four areas I had made notes about systematically and for each section I applied a format for giving feedback, along the lines of Pendleton’s rules. I did not adhere strictly to the “rules”, as I felt it would have become too time consuming and formal. As I provided feedback, I was able to highlight two to three key points from each main theme, which in other settings could have become learning points and I made notes of her comments of what went well and what could have been done better.

Providing feedback included noting my colleague had used the environment well. I thought the content was appropriate and took into account the range of experience amongst the audience and the content was presented clearly and in a structured and uncomplicated manner which was easily accessible. I fed back that her teaching style was engaging, held the attention of the audience, but was sometimes rushed, which was an area she felt she could improve. The interaction between her and the audience was dynamic and not confrontational. I noted the audience often wanted to ask questions as she spoke, as they had been given permission to ask questions at the beginning, but she often did not pick up on cues from the audience. I felt this occurred frequently and was significant and would require considerable improvement. In a formal setting I would have raised it as a learning objective, but as the setting for this feedback was more informal and my peer was also a friend, I merely tactfully commented upon what I had observed, but I did not highlight this aspect of the observation as a deficit that needed to be addressed. She noted herself she could have responded more to her audience’s non-verbal cues.

I provided the feedback immediately afterwards. I provided my colleague with the extensive notes I had made and the written summary generated during our feedback discussion and she thought the process had been very useful for her.

After the task, I considered that the process of giving feedback for this session could have been very difficult. My colleague had asked for my help, as a friend, to complete her assignment. I wanted to help, but I also felt hesitant in giving feedback – if I were too cautious, because I did not want to upset my friend and colleague, the value of the feedback would be diminished and may be of little value to her completing her assignment. On the other hand, if I were too rigorous in following a proscribed pattern and formality for providing feedback, I risked upsetting a friend. The concerns I had about providing effective feedback, not wishing to be too generalised or to damage our relationship has been commented on by Hesketh and Laidlaw (2002), alongside other barriers to providing effective feedback.

The process of providing feedback in the end was not difficult. I could attribute this to our working relationship and an informality in our approach to the task, but I actually think in hindsight that taking the step of carrying out a structured observation of specific themes, such as content, behaviour and interaction, was helpful for myself to be able to provide structured feedback about each aspect of the activity. I had never previously engaged in observation and feedback in this way before. In my previous experience of giving feedback, I realise I did not base this on conscious observations, but had relied upon unconscious processing and synthesis of what I had observed. I realise that in the past, when I gave feedback, this may for some people have felt unstructured or unfocussed, no matter how insightful. This has made me think whether in the past feedback I have provided was, if ever, formative.

In developing a structure for the observation I had not been sure what to do. Because the purpose of the assignment was to “capture” feedback of teaching, I drew upon my own understanding of the principles of effective feedback and “reverse engineered” a structure to use, that would support me providing feedback using Pendleton’s Rules. I was surprised how effective this was and also how resilient the “rules” were to being adapted, modified for this process. What I noticed using a structured approach was that I was able to be very specific and focused. The use of a structure enabled me to tease out difficulties more easily, communicate these points more precisely with examples and I can see how this would be very useful in contributing to identifying key learning points after a task.

The experience of being observed during teaching and the process of receiving critical feedback

I was observed presenting a proposed research project, to an audience of 35-40 people, including my peers, other Speciality Trainees, Academic Programme Trainers, Supervisors, Research Co-ordinators and Research Leads and guest speakers. The presentation was in the context of an entire day of teaching, focused on evidenced based medicine and the research programme within the Higher Specialist Training Scheme. I had earlier in the day delivered a presentation about the practical difficulties of incorporating adult learning principles within our Academic Training programme. For the afternoon, I had 10 to 20 minutes for my presentation, which was held after lunch. I was concerned that the audience might experience post-prandial somnolescence, as the whole day of presentations might be taxing, affecting the audience’s concentration. The purpose of my presentation was to stimulate a discussion about designing and developing research projects within the training scheme and was an opportunity for a peer discussion/review of a proposed project.

I had several concerns before this presentation. I was aware the audience would consist of several senior clinicians with extensive expertise in research. I felt I had prepared inadequately for the presentation and the level of detail had been difficult to judge, as I was aware I could be overly inclusive and I had struggled in planning how to convey the themes of the project to an audience in a 10 minute presentation.

I used PowerPoint slides to outline the research project, including some of the known evidence and theoretical basis for the research which I am interested in. The presentation took 10 minutes and then I invited questions and encouraged debate, which continued for 15 minutes. I had worried before starting the presentation that I would experience anxiety, as I had never attempted this type of presentation before and I had worried the audience might not understand or be critical or even hostile, but during the presentation, I was aware that this did not occur and found myself feeling more confident as I went along.

Overall, I felt I presented the research project well and communicated some key concepts to the audience. As I presented I made a conscious effort to engage with different audience members, in preparation to engage in discussion. As is my usual practice for any teaching/presentation, at the beginning I invited the audience to interrupt and ask questions at any time. In hindsight, on this occasion, I should have kept the opportunity for questions until after the presentation. The material being presented was conceptually dense and if taken piecemeal required significant clarification. This led to audience members seeking clarification frequently, which interrupted the delivery of the information as a whole as I had to move backwards or forwards through the material to re-demonstrate or expand upon a point. This became increasingly challenging and I attempted to convey key points succinctly and found myself in a position of not being able to answer questions because of the time constraints. I thought I had structured the content well and had taken care not to be repetitive. Following the presentation, I invited the audience to ask questions and express their thoughts or opinions for discussion of the topic and feasibility of the research project.

Afterwards, my colleague provided feedback. The feedback was not immediate, but several days later. I regretted this, as the experience was not fresh in my mind. She had attempted to make notes using several formats she had been introduced to during her PGCert Course, but she had found none of them were satisfactory (Appendix A). Instead, she made some short notes broadly divided into style, content and identified what could have been done differently (Appendix B).

I found the feedback given in part to be useful, but I felt the feedback was predominantly critical, although it did include some recommendations, an essential component of providing effective feedback as described by McKimm (2009). The more specific the feedback, the more I found myself able to acknowledge the validity of the feedback. I was provided with some specific examples, which also enabled some discussion and afforded me the opportunity to consider what I could have done differently. However, I thought as I was being given the feedback it would be unlikely I would change my behaviours as a consequence, mainly because I felt the quality of the feedback was poor and as commented by Norcini and Burch (2007), higher quality feedback is more likely to have an impact upon a learner’s behaviour.

I was surprised by some of my colleague’s observations – I felt I had clarified the objective of the presentation with an introductory outline. I was also aware of issues about clarification and questions from the audience. Interestingly, whereas I had thought the best option was to address all questions at the end, so I consciously ignored some cues, my peer observer thought I had not noticed the cues, reflecting our different perspectives on the experience. In a similar fashion, I was aware that small group discussions were “springing up” within the audience. My perspective was this was an excellent outcome, as one of the aims of the session was to stimulate discussion amongst ourselves.

Overall, when taking the feedback as a whole, I could appreciate which aspects of my style of teaching and communicating are effective and went well and also changes I could consider in improving the effectiveness of my teaching style. One change I would make consciously for the future would be to consider the pacing of any teaching- as I would interpret the majority of the feedback related to the speed and pace at which the presentation was delivered. By altering the pace at which I teach, I will hopefully introduce opportunities for an audience to participate more and through discussion facilitate more effective learning.