Giving feedback

E-portfolios, reflection and good quality written feedback webinar

See below recording of the e-portfolios, reflection and good quality written feedback webinar on 17 September 2024, focusing on the Foundation e-portfolio, exploring ways foundation doctors can engage with reflection and reflective writing and the benefits of good quality written feedback, and how both foundation doctors and supervisors and trainers can effectively engage with this.

What is the purpose of feedback?

High quality reflection in combination with supportive and constructive feedback is essential for the professional development of all doctors in training.

Feedback enhances and facilitates reflection, learning and improvement.

Regular feedback provides an invaluable measure of current against previous performance, allowing progress to be made toward successful completion of a training programme. In the case of foundation doctors (FDs), feedback on supervised learning events (SLEs) is used as e-portfolio evidence of learning, whilst the formal written feedback at the end of each placement (in the form of assessments such as the PSG, TAB and the clinical supervisor’s end of placement report (CSR)) guides the summative judgement against curriculum outcomes.

How should feedback be given?

Verbal feedback should be given informally as a regular part of day to day experiential learning. This should take place as soon as possible after each clinical encounter, after allowing time to listen to the FD’s reflections.

Feedback should take place in a private supportive environment, and be delivered in a sensitive manner, giving FDs a sense of being valued and respected.

Written feedback is more formal and should be provided at the end of each placement (and more often if appropriate). This requires preparation time and takes into account information obtained from the PSG and TAB, which contribute to the CSR. As with verbal feedback, it should be provided in a structured and supportive manner.

What are the characteristics of good feedback?

Good feedback is timely, accurate, honest, fair, specific and constructive. It should be directive, including an action plan for further development, taking into account both the expected level of performance of the FD and any cultural differences between FDs.

In summary, effective feedback should:

  • Facilitate and be guided by reflection
  • Be directed towards agreed learning goals
  • Be specific, relevant and descriptive
  • Be non-judgemental and focussed on FD behaviour
  • Confirm the FD’s understanding of the content
  • Include an action plan for future learning goals

Guidance for foundation doctors on providing written feedback for colleagues

Obtaining and acting on feedback is a key element of professional practice for all doctors. Feedback provides information for doctors on their performance, allowing them to understand from the point of view of others what is going well and what could be improved. The aim of written feedback is to record some of the information in a format that is available to the doctor and those supervising their training. However, the medium of text, particularly if provided anonymously, can make feedback difficult to process and has the potential to be misinterpreted in a way that may undermine its validity.

As a foundation doctor, it is likely you will be asked to provide feedback about colleagues during your training. By following the principles in this guide, we hope you are able to maximise the utility of your written feedback and avoid some of the pitfalls which can make it difficult for others to utilise your words in their professional development.

General principles

  • Treat your feedback as part of a conversation. You are offering your opinion to another professional about their practice. They are welcome to disagree, to ask questions about your views, and to seek the advice of others in how they interpret your words. This is not a marker of insight; it is part of how professionals process complex information.
  • Consider writing your feedback addressed to the individual. For example, ‘I observed you speaking to a family about their unwell relative…’
  • For feedback to be influential it must come from a credible source. You should maintain your own conduct in such a way that you are viewed as trustworthy and honest by your colleagues.

• Tailor the feedback you offer to the individual and be clear about the level of practice that is expected of them in their current role.
• Where possible, give specific examples of practice you have observed to support your opinions. For example, ‘I observed you speaking to a family about their unwell relative, you were calm and gave them time to share their views. This shows good communication skills and a caring manner.’
• Highlight what is going well.
• Highlight what could be even better and give examples of how this might be achieved.
• Ensure your feedback is actionable and enables the recipient to know where to go next with addressing areas for improvement.

• Share feedback that is poorly informed or based on hearsay from others.
• Provide dishonest or false feedback.
• Make assumptions in your approach to feedback. For example, don’t assume:
(1) You know why someone is having difficulties
(2) You know how someone will feel when they receive your feedback
(3) You know what someone’s motivations are

Anonymous feedback

Some forms of feedback, such as the Team Assessment of Behaviour (TAB), are designed to allow a wider range of respondents to share opinions about an individual. This principle is an important part of ensuring safety. Such feedback is usually acquired anonymously but you should be aware that in following the principles of giving detailed and specific feedback, which is illustrated by examples, you may make yourself identifiable. This is a balance, and it is a legitimate choice if you wish to make yourself identifiable in anonymous feedback formats.

Anonymity is likely to further diminish the ability to facilitate feedback as part of a conversation. This makes it all the more important that care is taken when constructing anonymous feedback to focus on how development might be addressed, and to avoid comments on personal attributes which could be seen as offensive when there is no ability to clarify meaning after the comment is made.

Disruptive or unfair feedback can undermine our sense of self-worth and be challenging to process on a personal and professional level. While responses in the TAB will always remain anonymous to the doctor receiving the feedback, respondents should be mindful that there are mechanisms through which they can be identified to the Foundation Programme team and instances of unprofessional or bullying comments by the responder will be investigated.

If you feel the need to share a specific concern and are not sure how you might do this in a constructive and productive way, you might find it helpful to discuss this with a peer, senior colleague, or member of your Training Programme. There are rare occasions when you may have a significant concern about a colleague’s professional practice and you should not feel the need to avoid such feedback. However there are additional mechanisms through which significant concerns can be raised anonymously, including through your employer and regulatory bodies, and you should use these processes.

Further resources