This guide is intended to help educational supervisors and programme directors more effectively facilitate an assessment feedback session. The vast majority of doctors who receive assessment feedback will have no significant concerns raised. The aim is to help them to focus on area/areas of their performance for development. Importantly, it is also a means of allowing them to build on and recognise their strengths. Because the assessment profile contains a lot of information it is helpful to give the trainee a bit of time to digest it before beginning the discussion.
Some general principles….
Feedback is important for learning because it:
- Provides acknowledgement of trainees’ acquisition of competence
- Provides guidelines for areas that need to be developed
- Provides motivation
- Provides insight
- Can lead to improved clinical practice
King provides a useful overview of effective feedback skills which includes 4 key stages:[1]
- The trainee is asked to start by identifying his or her own strengths
- The trainer reinforces these and adds further strengths
- The trainee is asked to identify areas for improvement
- The trainer reinforces these, adding further areas if necessary.
Hewson also provides a useful framework for giving feedback [2]. Again, there is an emphasis on getting the trainee to interpret feedback first and engaging them in developing strategies for further development.
Mini-PAT Feedback
Mini-PAT gathers information across a range of performance domains of Good Medical Practice and the Foundation curriculum. It is therefore important to review what it says systematically and try to see if there are common patterns. Remember when reviewing mini-ePAT feedback that the questions are arranged in 6 domains and some global questions:
1-5 Good Clinical Care;
6-8 Maintaining Good Medical Practice;
9 Teaching and Training;
10-12 Communication with patients;
13-16 Communication and working with colleagues.
17 Overall impression
Health & Probity
Any Other Concerns
Any Other Comments
When meeting with a trainee to provide them with their feedback it is helpful to give them a few minutes to look through the feedback first before beginning the discussion – perhaps make both of you a cup of tea while they do this!
Some pointers
Average score for the questionnaire
mini-PAT is not an instrument that allows ranking of trainees. There are two reasons for this: firstly the assessors are explicitly asked to score a trainee against a scale, not comparing one trainee with another; secondly the standardisation of the process from Trust to Trust, Deanery to Deanery has yet to be assured enough to make such a comparison fair. However if a trainee is evidently at the lower end of the group then this should be explored. Remember any trainee scoring less than 4.0 overall has been assessed to be falling short of the standard expected to complete their year. This may of course be very appropriate early in each year.
Trainee over-scoring
Look at how the trainee scored themselves compared to their actual ratings by their colleagues – how does the trainee see themselves? Are there consistent or striking differences between their perception of their performance (self rating) and the perceptions of their assessors? Consistently scoring yourself higher than you are actually scored suggests that there may be a problem with over confidence or lack of insight. Is this across the board or just in focussed areas like management and team work – which often appear together- or in the clinical areas?
Trainee underscoring
This is quite common. Focussing on recognising strengths and building confidence may need to be the main focus of your discussion.
Free text
Many doctors who have had feedback using mini-PAT say that they particularly value the free text component. Read the comments carefully before meeting with the trainee before reaching your own conclusions. Try and relate them, if you can, to the profile of scores. Go through the comments with the trainee endorsing the positive ones and try to facilitate development planning in response to constructive criticism. Where there is a single rogue comment an important role for the facilitator/supervisor is to try and reduce the impact of this by focusing on other more positive aspects of the feedback.
Summary
There is a lot of information on the mini-PAT feedback sheet, and it is easy to glance at it and not look in detail for areas that may help this trainee to improve their performance, and/ or their understanding of themselves. Looking slowly and carefully makes it a more productive exercise providing you and the trainee with good evidence across the curriculum.