By Theresa Suart & Eleni Katsoulas
Giving and receiving feedback effectively is a key part of the UGME curriculum. It’s also key in nearly every workplace, which could explain why there are so many different frameworks and recommendations for feedback “best practices”. Some of these are more effective than others.
Have you heard of the feedback sandwich? It’s one of the more popular feedback techniques and involves “sandwiching” negative or constructive feedback with two pieces of positive or complementary feedback. It’s also sometimes known as “PIP” for “praise, improve, praise”.
The idea behind this is laudable – cushion the blow of negative feedback and reassure the individual that they are doing some things well.
In practice, however, it’s fraught with difficulties, making it not very useful for the person receiving the feedback. Think about it:
- I’ve just received two pieces of praise and one of criticism or a suggestion for improvement: what should I focus on?
- The negative feedback is about something I did today, the positive things were from last week – the positive stuff must not be as important.
- Two pieces of praise and one of criticism – guess that I’m mostly doing well!
- The last thing they said was praise – must be doing great!
Writing in Harvard Business Review, Roger Schwarz also points out the fallacies of this approach. Schwarz notes leaders who use the sandwich approach to negative feedback do so for a variety of reasons. These include:
- Thinking it’s easier for people to hear and accept negative feedback when it comes with positive feedback.
- Assuming the sandwich approach provides balanced feedback
- Believing giving positive feedback with negative feedback reduces discomfort and anxiety.
Schwarz then debunks each:
- Easier: Most people on the receiving end would prefer to skip the sandwich – get to the point.
- Balanced: Saving up positive feedback to sandwich negative feedback undermines timely delivery of the positive feedback. As Schwarz points out, research shows that feedback, either positive or negative, “is best shared as soon as possible.” He also asks: “Do you also feel the need to balance your positive feedback with negative feedback?”
- Reducing anxiety: “The longer you talk without giving the negative feedback, the more uncomfortable you’re likely to become as you anticipate giving the negative news.” Meanwhile, the person on the receiving end “will sense your discomfort and become more anxious.
The UGME Education Team advocates the use of a new feedback sandwich replacing “praise, improve, praise” with Ask – Tell – Ask. This method was brought forward by Dr. Ayca Toprak and Dr. Susan Chamberlain, adapted from French, Colbert and Pien (ASE April 24, 2015)
The ATA Feedback Model is similar to the traditional feedback model as it has three parts. After that, it’s quite a bit different. Using Ask-Tell-Ask, the Preceptor asks the learner for their input, then the preceptor tells them their impressions, then wraps up by asking the learner to help develop an improvement plan:
Ask – Tell – Ask
- Ask the learner for their perceptions about strengths and challenges
- Tell them your impressions backed by observations, and specific examples
- Ask them what can be improved and how– assist you in developing a learning plan
Examples of topics to discuss (referencing objectives of the rotation, course, or activity):
- Functioning in the team context
- Skills (communication, technical, clinical)
- Clinical Reasoning
- Record keeping
- Process or Content (knowledge or the way they use the knowledge; application of knowledge).
- Background knowledge (this is knowledge of the discipline, scientific foundations, knowledge base).
The ATA model helps preceptors focus the discussion while scaffolding self-regulation and self-assessment. It also avoids the mixed-messages of the feedback sandwich approach.
The ask-tell-ask oral feedback is best paired with written narrative feedback. Watch for a blog post on this topic in September.
We used PowerPoint slides from a presentation prepared by Sheila Pinchin and Eleni Katsoulas, with slides from Cherie Jones, to prepare this blog. We thank Sheila and Cherie for their contributions.