Visioli Sonia 1,2 ,Montagna Licia 1,2 , Oldani Silvia 2,3 , Spinelli Antonino 2,4 , Zannini Lucia 1 , Roncalli Massimo 2,5 , Montorsi Marco 2,4 , Albini Marco 2 , Scherpbier Albert 6 1 Chair of Pedagogy, Department of Public Health, University of Milan; 2 Humanitas Clinical Institute, Milan; 3 Department of Internal Medicine, University of Milan; 4 General Surgery, University of Milan; 5 Department of Pathology, University of Milan; 6 Scientific director, Institute for Education; Faculty Health, Medicine and Life Sciences, University of Maastricht Giving feedback can reinforce the learners' performance and enhance their motiva- tion to improve it, but it can also decrease the performance and de-motivate learn- ers if not properly given. There is a general agreement on the usefulness of feed- back in the learning environment and many theoretical suggestions on how to pro- vide feedback can be found in literature. Nevertheless, little is known about the real practice of providing feedback in clinical workplaces. Summary of work The study aims to investigate: 1. the type of feedback given to students and 2. the feedback skills exhibited by clinical teachers. During two consecutive academic years (2007-2008 and 2008-2009) four trained observers (SV, LM, SO, AS) reported on a structured grid 109 formative feedback moments given by 11 clinical teachers to 64 3 rd year medical students. Feedback was given in a one-to-one session. All the teachers consented to be observed for this purpose. Clinical teachers previously shared their practical experience of the Clinical Examination (CE) and then achieved an agreement on how each CE skill should be performed. Clinical educators approved a common check list on CE (shared with students and then scored by all teachers). Moƌeoǀeƌ, ĐliŶiĐal teaĐheƌs atteŶded a tƌaiŶiŶg Đouƌse oŶ giǀiŶg aŶd ƌeĐeiǀiŶg feedďaĐk ;L), SV). For these reasons, teachers were expected to give feedback without relevant discrepan- cies from each other. Data collection and analysis In order to collect objective and statistical data, we created a structured observational grid di- ǀided iŶ tǁo paƌts, aiŵed to oďseƌǀe the ĐliŶiĐal teaĐheƌ’s eduĐatioŶal ďehaǀiouƌs aŶd the feedback's features. (see Table 1) The grid was filled out by an observer who sat in the room and was recognizable but he/she didn't actively participate in the feedback session. The collected quantitative data were analyzed with the statistical package Excel. Results and discussion In 98% of the cases feedback was gƌouŶded oŶ diƌeĐt oďseƌǀatioŶ of studeŶts’ peƌfoƌŵaŶĐe. The ŵost fƌeƋueŶt tLJpe of feedďaĐk ǁas the ŵidžed ;ϱϮ%Ϳ, folloǁed ďLJ the positiǀe ;Ϯϰ%Ϳ aŶd the saŶdǁiĐh ϮϬ% feedďaĐk; oŶlLJ ϰ% ǁeƌe Ŷegatiǀe feedďaĐk. In giving feedback, teachers suggested aƌeas that Ŷeed to ďe iŵpƌoǀed ;8Ϯ%Ϳ; stƌoŶg poiŶts aŶd ǁeak poiŶts of studeŶts’ peƌfoƌŵaŶĐes ǁeƌe seldoŵ eluĐidated ;ϲϱ% aŶd ϲϬ% respectively). Each feedback session took from 3 to 15 minutes and during the session the teachers asked the student to perform no more than 2 skills. From our observational research results that giving feedback is primarily intended by teachers as a strategy to communicate what students should improve on, not only what they did wrong. Nevertheless, teachers tend clearly to forget to elucidate to students the weak points of their performances. However, according with the guidelines indicated by literature on feed- ďaĐk, teaĐheƌs Ŷeǀeƌ ƌefeƌ to studeŶts’ peƌsoŶal Ƌualities. OŶlLJ iŶ ƌaƌe Đases teaĐheƌs sug- gested to the studeŶt to ďe ŵoƌe self ĐoŶfideŶt oƌ less tiŵid. We oďseƌǀed that geŶeƌallLJ clinical educators succeed in creating a constructive, non-evaluative feedback session. Teacher behaviour: Scoring * Grounds feedback on observed facts 1 2 3 4 Refers to specific steps of the manoeuvre observed 1 2 3 4 Accurately suggests steps or areas that need to be improved 1 2 3 4 Gives examples to explain the feedback 1 2 3 4 Provides theoretical explanations, if needed 1 2 3 4 Elicits strong points 1 2 3 4 Elicits weak points 1 2 3 4 Veƌifies the leǀel of studeŶt’s feedďaĐk ĐoŵpƌeheŶsioŶ 1 2 3 4 Refers to studeŶt’s ĐhaƌaĐteƌ Ƌualities ;too much timid, not enough friendly…Ϳ ;iŶ this iteŵ ϭ is the ŵost positiǀe ďehaǀiouƌͿ 1 2 3 4 Feedback's features: Quantity of manoeuvres discussed Duration of each feedback (minutes) (specify if each feedback is related to previous manoeuvres or not) Type of each feedback provided P=positive; N=negative; M=mix; S=sandwich(P-N-P) Free text *Scoring 1 = the teacher never exhibits the feedback skill; 2 = the teacher exhibits the skill for very few steps of the manoeuvre observed (less than 50% of the steps); 3 = the teacher exhibits the skill for almost all the steps of the observed manoeuvre (more than 50% of the steps); 4 =the teacher exhibits the skill for every step of the observed manoeuvre References Bing-You RG, Trowbridge RL. Why Medical Educators May Be Failing at Feedback. JAMA 2009; Sep 23 – Sep 30, Vol. 302, Iss. 12; p. 1330. Gil DH, Heins M, Jones PB. Perceptions of medical school faculty members and students on clinical clerkship feedback. J Med Educ. 1984: 59:856-64. Hewson MG, Little LL. Giving Feedback in Medical Education – Verification of Recommended Techniques. J Gen Intern Med 1998; 13: 111-116. Take home message Training clinical teachers to give feedback, and developing observational activities aimed to give them feedback, can significantly contribute to the construction of a positive learning environment that is fundamental to succeed in clinical training. Sargeant JM, Mann KV, van der Vleuten CP, Metsemakers JF. Reflection: a link between receiving and using assessment feedback. Adv. in Health Sci Educ 2009: 14:399-410. Veloski J, Boex JR, Grasberger MJ, Evans A, Wolson DB. Systematic review of the literature on assessment, feedback and physicians clinical performance. Med Teacher 2006; 28: 117-128 (BEME Guide No. 7). Visioli S., Oldani S., Spinelli A., Montagna L., Montorsi M., Roncalli M., Zannini L., Giving written feedback in workplaces: What do preceptors ŵaiŶlLJ focus oŶ studeŶts’ cliŶical edžperieŶce?, EducacióŶ Médica, ϭϮ ;Supl ϮͿ: SϮϳϲ, ϮϬϬ9. Visioli S, Lodi G, Carrassi A, Zannini L. The role of observational research in improving faculty lecturing skills: a qualitative study in an Italian dental school. Medical Teacher 2009; 31:8: 362-369. Acknowledgments: We thank the clinical teachers who consented to be observed and to reflect with us on their giving feedback practice: Dr. Salvatore Badalamenti, Dr. Umberto Cariboni, Dr. Michele Ciccarelli, Dr. Matteo Incarbone, Dr. Manuel Marconi, Dr. Paolo Omodei, Dr. Stefano Ottolini, Dr. Marco Luciano Rossi, Dr. Luisa Ulian, Dr. Antonio Voza, Dr. Dennis Zavalloni Parenti. Graphics: R. Mantovani 2010 Italy Address for correspondence:sonia.visioli@unimi.it; sonia.visioli@humanitas.it Istituto Clinico Humanitas; Via Manzoni 113 20090; Rozzano (Milan) Italy