Marilen C. Martinez, Pharm.D., BCPS, Henry Ford Macomb Hospital, Clinton Township
Feedback is an essential component of experiential training for student pharmacists and residents. The American Society of Health-System Pharmacists (ASHP) Accreditation Standards for PGY-1 Residency note that preceptors must provide ongoing feedback to residents about how they are progressing and how they can improve. It should be frequent, immediate, specific and constructive.1 Activities that can trigger feedback include presentations, answering drug information questions, making recommendations during rounds, patient counseling sessions or the completion of a project. Feedback is essential to learning, however student pharmacists and residents may not recognize that feedback has been provided. Preceptors may be providing feedback on a regular basis, but the trainees may not perceive it that way. At the beginning of the rotation, it is important to discuss how feedback will be provided to mitigate any confusion.
It is notable to distinguish the difference between feedback and evaluation. Although used similarly, they can serve two different purposes. Both provide information to the trainee to improve her or his performance and can encourage self-assessment. Feedback, or formative assessment, is an ongoing evaluation of the trainee and can be used to provide information on actions that were directly observed. Evaluation, or summative assessment, is used to measure the trainee’s achievement of a goal, usually at the end of an activity or rotation. Feedback is most typically thought of as an informal, short discussion, compared to evaluation which is thought of as a formal, extended discussion. Feedback reinforces good practices, corrects mistakes and modifies behavior, all while working toward the goals of the experience. Evaluation usually grades the experiences and reviews how goals were met. It also provides suggestions for future experiences.2,3
There are several approaches to providing feedback. A commonly used approach is the Feedback Sandwich which provides positive feedback, followed by a corrective statement, then closes with another piece of positive feedback. This method may be helpful to ‘soften the blow’ of the constructive criticism so the trainee may be able to accept the negative feedback and avoid becoming defensive. Another approach is the Pendleton Four-Step Model, where 1) the trainee states what is good about her or his performance, 2) the preceptor states areas of agreement and elaborates on good performance, 3) the trainee describes areas of improvement, and 4) the preceptor states what could be improved. This approach allows for the trainee to self-evaluate her or his performance and develop a self-awareness of her or his own strengths and weaknesses. The last approach is the Situation-Behavior-Impact (SBI) Feedback Tool that was developed by the Center for Creative Leadership and has three distinct parts. The first is situation, which is when the preceptor defines when and where a performance was addressed so the feedback is put into context of a specific setting and time of reference. The second part is for the preceptor to describe specific behavior that was witnessed directly without assumptions or subjective judgement of that behavior. The third and final part is impact, where a preceptor describes how the behavior affected the trainee or the patient.2
Even with these feedback techniques, providing difficult or negative feedback to a trainee can be challenging. constructive feedback may be necessary when the trainee has displayed unprofessional behavior, is unprepared for rotational activities, or has not completed an assignment. Another preceptor or program director present when providing negative feedback may be considered. The preceptor may reframe the bad news, for example if a trainee is not meeting expectations, as an opportunity for improvement. The preceptor should be direct about the issue and should provide a stepwise plan to improve the trainee’s performance. It is important to allow the trainee to provide her or his own thoughts about the negative feedback. Lastly, the preceptor should point out what is working well along with what needs additional work.2
Feedback is crucial for a pharmacy trainee’s learning but often there are obstacles and challenges when providing feedback. By providing timely feedback with specific examples, preceptors can improve their skills and trainees may have a great appreciation for the quality of guidance that was offered.
1. American Society of Health-System Pharmacists. ASHP accreditation standards for residencies in pharmacy practice. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy1-residency-accreditation-standard-2016.ashx?la=en&hash=9FF7C76962C10562D567F73184FAA45BA7E186CB (accessed 2020 Feb. 20).
2. Soric MM, Schneider SR, Wisneski SS. The effective pharmacy preceptor. Bethesda, MD: American Society of Heath-System Pharmacists, 2017.
3. Grover B, Hayes BD, Watson K. Feedback in clinical pharmacy education. Am J Health-Syst Pharm. 2014;71:1592-6.