Feedback - The SimulaFunIst

#moc/publish | #on/feedback # What's the big idea here? - Feedback is any information we get about ourselves, [[it's all data]]. - Some feedback is intentional, generally poorly delivered, at the wrong time in the wrong way, we should get good at [[Receiving Feedback]]. Other feedback is [[accidental feedback]], observations the real world gives us about our performance or behavior. - When giving feedback, start by [[Teaming by Amy Edmondson]] with the goal of creating a moment of solving a problem together (Telio et al., 2015). - When feedback happens between two people, it is relationship based, and therefor lives in the same space as [[psychological safety]]and [[social-cognitive learning theory]]. - Consider the values in the feedback team, focus on [[Teaming by Amy Edmondson]] for [[learning]], identity formation (Molloy et al., 2020) - The recipient has to integrate the new information into their old identity and ways of doing things. They often receive contradictory information over time. Help them reconcile your feedback with what they've heard before, [[facilitating]] is the skill required here, and it's facilitation of the conversation between their old self and their new self. (Pardhan et al., 2023) - When giving feedback, use the [[Basic Assumption]] to keep your curiosity. Explore their thinking with the [[I saw I think I wonder]] to find their frames and make incremental improvements to those frames. - The greatest leverage is to be able to improve the receiving of feedback (Tielemans et al., 2023), since it comes from so many directions. [[modeling vulnerability]] is the way to develop a feedback culture if you are in a position of authority. Stay [[curiosity]], to get over the emotional triggers that block our ability to receive feedback successfully look for what is different about what you saw, instead of what is wrong about their feedback - The best feedback comes in [[Systems]], include observable past actions, present conversation, future actions, [[Forming Habits]]s or other opportunity to demonstrate change and get more feedback. These should be connected to other goals of your program, organization, etc. - Coach the coach, help others give you better feedback by clarifying and separating evaluation, coaching, and appreciation. Tell them what you need - Learn about yourself; how do you respond to different types of feedback, what are your triggers and blockers, how can you learn about your blind spots? How does time factor into how you receive feedback? Do you struggle in the moment but incorporate it later? Let the people know how you process feedback. ## Feedback is a conversation - governed by [[social-cognitive learning theory]], meaning it is a social interaction with values, norms, cultural expectations, etc. - It doesn't matter what you say, it matters the meaning they make using [[Constructivism]] - [[Forming Identity]], [[Relating]], and truth triggers can block effective feedback ### Frameworks for Effective Feedback (Liakos, 2023) ![[Frameworks_for_Effective_Feedback_in_Health.41.pdf]] %% ## Giving Feedback: Models ### Pendleton ![[Pasted image 20220720142521.png]] ### ADAPT ![[ADAPT Model.jpg]] [https://sites.uw.edu/uwgme/adapt/](https://sites.uw.edu/uwgme/adapt/) What I think these and similar models are missing, They are mostly evaluative, self-evaluative compared to outside observer and coaching, they do not cause deep reflection necessarily. This is good for single loop learning, and potentially for learning about yourself and how you evaluate yourself compared to how others see you. %% ![[single double loop from DWGJ.jpg]] (Rudolph, 2006) ### With Good Judgment Transparency in thinking, high standards and high regard for them as humans ![[The Basic Assumption (TM)]] #### Introduction: think about when/where: - Context plays a big role in how well feedback is heard - Are they ready for the feedback. Public vs. private location, team conversation or just to one person - Check in: - "I'd love to talk about your intubation, would this be a good time for some advice?" Reframing as advice can be a helpful way to talk when feedback has become a charged word for some. #### Negotiate the topic Here you collaborate to discover what important ideas you both want to explore, and set a shared agenda for the conversation. #### Use the advocacy-inquiry molecule: [[I saw I think I wonder]] Useful in any situation like negotiation, feedback, debriefing, and conflict management, this approach helps you quickly discover what people are thinking. - Preview the topic - I saw - I think - I wonder I'd like to talk about I saw (directly observable!) I think (what you think and why this matters) I wonder ... what was going on for you when you ... #### Listen to and gently move their thinking - What are they saying, what drove their action? What were they feeling? - Repeat it back in your own words to acknowledge and validate your understanding through [[🐓 Idea Farm/3 Inbox of ideas/empathic listening]] with the goal of listening for [[That's exactly right]] - Now you can have a conversation around their frames, their understanding, etc. It could be knowledge, often it's situational awareness, emotion, cultural influences, that factored in. You won't change that with information. - Don't answer feelings with facts (Rock, 2020), [[name it to tame it]] because [[naming emotion decreases activation]] and [[emotion and cognition interact to effect learning and memory and decisions]]. - Have a [[Socratic questioning]] session, where you explore with permission, ask what the opposite would do, play the devil's advocate, or have them take another position. You are looking to expand their mind for possible solutions. If the better solution comes from them, you both might learn something. - If in a group, believe the best answer for the group isn't from you, but from within their own peers. Beware the [[Expert Blind Spot]], experts necessarily cannot see what novices need to know to improve. #### You should seek to understand what they heard - Don't assume you know what they are taking away #### Plan future action - How are they going to implement their new idea? - Use [[Implementation intentions]], when I ... I will ... - What will get in their way? What predictable barriers will they face? - How will they know then celebrate when they do the improved method? #### Feedback should include follow-up - people need an opportunity to show they've made a change - change doesn't always happen at the time of the feedback - let change happen at the pace that it needs to happen. Some people get emotional, then process, then can act later. %% **Contrast to...** ### Hidden Judgement We don't say what we are thinking to try to protect their feelings - _Guess what I'm thinking?_ - Do you think you might have done something different that time? this approach unfortunately puts their mental energy in figuring you out, what you want, not what they did ### Harsh Judgement We are frustrated with them (often for something that happened previously or something you are worried about happening) and it comes out harshly - _You should be better!_ - What could you have been thinking when you ... ? Frustration in a power differential comes across as anger. They are not psychologically safe to learn, to reflect, or to grow. They are focused on self-protection, and will say whatever to get you to stop. %% ## Receiving Feedback: ### Modeling _[[the way to change the world is by changing yourself]]_ - The higher you are in an organization, the bigger influence you have purely by modeling - You can only hope to change yourself, and the world will change around you when you can work to explicitly create better feedback for yourself - Others will see how it works and start adopting the behaviors ### Three stages of receiving feedback - Fuck - I suck - Now what #### Common Pitfalls in Receiving Feedback (Tielemans et al., 2023) ![[Receiving_Feedback_Is_Not_Easy__Six_Common.40.pdf]] ### [[start with why]] - Work hard up front to apply [[Listening to Understand]] the intentions of the person giving you feedback - Separate [[Coaching]], [[Assessing]], and [[appreciation balances our negative tilt]] - use [[relational coordination]] - work to match your goals with the giver's goals - you may be fortunate enough for them to be identifying a [[Blind Spot]], so when you hear one of your [[Triggers]] you need to overcome your initial reaction - Triggers can be - [[Identity]] Triggers: we might be - Relationships where we are always [[Teaming by Amy Edmondson]] - Informational [[Truth Tiggers]]: we might be [[listening to win]] - [[shift from that’s wrong to why is that different]] -> or even why is it right ### separate who from what to not miss the valuable information - disentangle the relationship from the ideas - discussing BOTH is the power move, because BOTH are at play - Relationships are [[Systems]] with feedback loops - identify the feelings and needs at play, since [[emotion changes the world we are in]] - Feedback needs to come from credible sources for it to be credible itself ### First seek to understand - What type of feedback is it? - Coaching: I have a better way - Appreciation: I am happy you are here - Evaluation: where do you stand ### We need evaluation know where we stand - if all we get our appreciation and coaching we fell in impression of the evaluation based on that which makes the other two less effective - Some people can be demotivated by evaluation, where others are motivated - Demotivation can be from having been told they are now good enough, or being too far from achieving their goals. See if you can help them see that they are in their [[zone of proximal development]]. ### [[Explicit disagreement is better than implicit misunderstanding]] - **relational stress happens when we expect one form of communication and get another** - we need appreciation and get coaching -> heard as criticisms - [[we are all the hero of our own story]] ### Give yourself a second score - For how you handle the feedback - This is an example of [[sharpen the saw]] - Did you utilize a growth [[Mindset]]? - Did you properly [[Identifying Reality]]? - Did you ensure you separated the strands of assessment, appreciation and coaching? - Remember that your [[emotion changes the world we are in]], and since [[it's all data]] and you only capture a small part of the available data, you have [[Blind Spot]]s and the hardest things to hear, sometimes from the people who are hardest to hear it from, might be your blind spot at work - Since [[The Obstacle Is the Way]], this might help you identify the real obstacle - [[embrace your hypocrisy]] - when someone gives you painful feedback, they might be telling you when you are being hypocritical. We all do it. This is an opportunity to dig deep, why did you say one thing and do another? Likely cultural or identity elements are at play to being barriers to receiving the feedback %% ### Self Reflection: ![[trainee self reflection based feedback]] %% ## A systems approach to feedback People exist in [[Systems]], so when considering actions it’s important to view the layers at play - The interactions between the players - The roles assigned to the players - The purpose assigned to those roles All of those layers may contribute to the interactions ![[Feedback Procewss and Outcomes.jpg]] (Lefroy, 2015) ## Problems in Feedback ### Barriers to feedback - relational concerns: it is hardest to give feedback when you are concerned about upsetting someone - lack of direct observation: when only the outcome is known, the feedback can be off, or can be too general which is unhelpful. - trying to move someone too far: narrow, small, achievable pieces are better than wholesale changesf - self-assessment focused feedback: low-performers over-estimate, high-performers under-estimate (Dunning Kruger, etc.) [[competence and confidence are not linked]] ### Switch tracking When the original feedback causes a reaction that introduces a second topic. The second topic is important to the receiver and needs to be addressed, but it’s not the same topic. Acknowledge that it’s important (likely a trigger from previous list, knowledge, relationship, identity), capture it, and negotiate around which topic to discuss first. Key here, the most important indicator of future conflict is past un-resolved conflict. ### [[Fundamental Attribution Error]] - Intentions and impacts We focus on our intentions and we are blind to our impact, we need to separate these two ideas and focus on the impact during our feedback moments - A [[Blind Spot]] is our impact, people do us a favor when they tell us things, even when painful [[Assessing]] contains both [[Coaching]] AND Ranking. Separate them and use them for what they are. Use the coaching as coaching. Use the ranking as information for where you are at. ### Feedback is not mandatory - be precise when you ask for feedback, are you looking for input or will they get to choose - You can decide if you want to hear about it at all - sometimes you need to be able to say “Not now.” [[If you cannot say no then you cannot choose your yesses]] - You can even choose to leave the relationship if the feedback continues in a destructive way - How can you tell how to tell when to say No? %% --- ## Unrequited notes (by link) _update when creating MOC to point to this note_ These notes point directly to this note. But this note doesn't point back. ```dataview table file.mtime.year + "-" + file.mtime.month + "-" + file.mtime.day as Modified from [[Feedback]] and !outgoing([[Feedback]]) sort file.mtime desc ``` ## Associated notes (by tag) _Update when creating MOC to point to this tag_ These notes have this associated tag: #on/feedback ```dataview table file.mtime.year + "-" + file.mtime.month + "-" + file.mtime.day as Modified from #on/feedback and !outgoing([[Feedback]]) sort file.mtime desc ``` %% ## Sources: Armson, H., Lockyer, J. M., Zetkulic, M., Könings, K. D., & Sargeant, J. (2019). Identifying coaching skills to improve feedback use in postgraduate medical education. _Medical Education_, _53_(5), 477–493. [https://doi.org/10.1111/medu.13818](https://doi.org/10.1111/medu.13818) Atkinson, A., Watling, C. J., & Brand, P. L. P. (2022). Feedback and coaching. _European Journal of Pediatrics_, _181_(2), 441–446. 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