Today I read an interesting paper in Medical Education titled Feedback, the various tasks of the doctor, and the feedforward alternative.
The authors comprehensively review the unintentional damage that feedback may cause to both motivation and performance. In a nice review of the literature and in a meta-analysis, the evidence suggests that traditional feedback can have complex, and at times negative results, thereby impairing performance. At play here is a self-regulatory theory with two distinct foci: prevention-a state of mind characterized by vigilance and concern with punishment, and, promotion -a state of mind characterized by eagerness and concern with rewards.
In essence, the evaluator must understand the self-regulatory focus of the learner so as to best understand the impact of feedback. The authors argue that positive feedback motivates more than negative feedback under a promotion focus and that this effect reverses under a prevention focus.
Are you still with me?
Next, they propose the Feedforward interview technique. If done properly, this indeed is an exploratory, self reflective, interview between student and teacher. The authors cite limited data in support of the new technique.
The components are:
- Introduction: set a positive tone
- Story: the learner must recall a life or work story that led to personal fulfillment
- Peak: the learner must recall the peak moment and psychological reaction
- The conditions: the learner must explore what allowed for the story/peak experience
- The feedforward question: To what extent/degree does the current work and educational experience bring the learner closer/take away from the condition of happiness and fulfillment?
The feedforward approach may be too Ivory Tower, even for the Ivory Tower. Here is why this may not play out in reality:
- Many medical schools educate 150+ students per year in clinical clerkships. Most struggle to simply get physicians to complete a written student evaluation.
- Feedforward student interviews would be time consuming. Without a structural change that actually provides protected time for teaching and formal feedback sessions, this will fall by the wayside.
- Extensive training of both evaluator and learner will be required to implement the feedforward interview.
- The feedforward evaluator must understand the self-regulatory focus (promotion vs prevention) of the learner whereas in the traditional model, feedback is dependent upon the observational skills of the mentor. I suspect that the former is less natural than the latter for most physician educators.
Feedforward interviewing may simply be too forward thinking in the current structure of medical education.
My apologies for today’s unduly long commentary.
