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    Veterinary Nursing Placements

    Clinical Coach Guidance and Resources

    This section aims to provide advice and support to enable successful clinical coaching within the practice environment.

      

    RCVS documentation and guidance

    Getting started with a new student

    Support for the Clinical Coach

    It is essential that any clinical coach has the support of senior management in carrying out their role. Whilst it is completely appreciated that a veterinary practice is a business, if the practice has committed to training students, there needs to be appropriate time allowed for this to take place. We all know that no one day is the same in practice and staff shortages and/or emergencies can impact on time that might otherwise be set aside for training students. However, when this is occurring on a regular basis, a student’s training can be disadvantaged. This in turn can lead to frustration, low morale and ultimately a desire to move on. Therefore, time management and organisation is key. For you to carry out your role successfully, senior management may need to make allowances or adaptions to ensure you have adequate time.

    Your IQAV is there to offer support and guidance at any stage of the clinical coaching process. They have a breadth of experience in all areas of student veterinary nurse training and will make realistic suggestions to help you overcome any problems encountered along the way. Should the need arise, they can also liaise with senior management regarding training matters.

    Matching Students to Clinical Coaches

    Not every practice will have the luxury of being able to ‘match’ a student to a clinical coach, but successful clinical coaching will be dependent on developing a good working relationship with your student(s).

    Spending time with your student and inducting them into training will allow you both to get to know one another a bit better, but also consider the following and how you might need to approach these:

    • Your position within the practice
      You can be the loveliest person in the world, but if you hold a position of authority, for example head nurse, be aware that some students can be intimidated by this and may react differently around you for fear of making mistakes and feeling silly.
    • Your availability
      Some students may not wish to bother you with questions or queries if they can see that you are constantly run off your feet. As students often require reassurance or wish to get feedback from their clinical coach that they are progressing as expected, a lack of availability can have a detrimental effect on the student’s development.
    • Your relationship with the student
      Is there an obvious clash of personality? Are you good friends with them?

    It is usual that a simple conversation as part of induction with the student can ‘iron out’ any worries and provide any required reassurance in these areas.

    The Importance of Induction

    Many practices will have a formal induction process in place for new staff to include provision of health and safety information, collection of personal data such as medical questionnaires and processes to familiarise with practice protocols and use of computer systems.

    From a student training point of view, getting to know your student is essential to starting the coaching process. A meeting to undertake an induction, and also discuss your expectations of the student (and vice versa) will provide a solid foundation upon which to build and develop.

    There can often be subtle but definite differences between student and clinical coach expectations with clinical placement, so it is a really good idea to sit down with your student at the start of placement to discuss this. Doing so means that all parties are clear about what they can expect from one another as far as the student’s practical training is concerned. Things to consider here include:

    • How the practice usually functions for the training of student veterinary nurses – who else will be involved and how they will feedback to the clinical coach about the student’s progress.
    • The time the student can expect to spend with the clinical coach – both from a practical working and progress review perspective.
    • What you expect from your student in preparation for progress reviews, e.g. if you want to see a student led approach with reflection on the skills they are working towards/feel competent in.
    • Health and wellbeing – what to do if feeling overwhelmed with everything there is to learn and remember.

    It might be that this discussion forms part of the student’s initial induction to the practice, or this might be done a short time after, also incorporating NPL planning.

    At the request of practices, we have developed a practical training agreement that can be downloaded and adapted and used with your student if you wish. This is not a requirement of the University, but clinical coaches that have used this have fed back to us that it outlined expectations that otherwise could have caused miscommunication/misunderstanding at a later date.

    The following should be considered for an NPL induction:

    The student’s previous experience

    Consider the bigger picture here and not just relevant experience in a veterinary practice. For example, it may be that your student has previously had a part time job working with the public, or volunteering with the elderly demonstrating excellent communication skills and developing rapport.

    Any potential barriers to learning

    When we talk about barriers to learning, there is the tendency to assume this relates to learning difficulties such as dyslexia or dyspraxia. Whilst these should absolutely considered, along with any reasonable adjustments required, a barrier to learning may also include things like previous bad experience, a phobia or a feeling of intimidation. For example, having been bitten by a cat or dog in past, or being intimidated when asked to assist the practice principal.

    How do you and your student learn?

    Educational research has shown that by becoming more aware of how you learn, you can become a more efficient and effective learner. As a clinical coach, knowledge of both your own learning style(s), and that of your student, can help you identify the best methods to use when training. You can use this information to advise other staff that will be involved what works best.

    A learning styles questionnaire can be a quick and easy method of finding out learning preferences. Please see the link to such a questionnaire.

    Long term goals

    What is the end goal, e.g. achieving competence in the day one competencies and skills, and when does the student need to have achieved this by?

    Short term goals

    Based on discussion of all the above points, where have you both agreed the student will start? Set targets to work towards and a date to review progress with these. As a clinical coach this may also involve you facilitating student training with other members of the team, e.g. reception.

    Review of progress

    What is the format for this? When will meetings take place and what preparation (if any) is required? Some practices like to introduce a practical training agreement that clearly outlines what is expected of the student, and what in turn they can expect from their clinical coach.

    The University has developed a Student and Clinical Coach NPL Planning Tool and we have asked your student to complete sections 1 and 2 of this in preparation for their first meeting with their clinical coach. It aims to provide information based on the points above that can ultimately feed into a plan of action as far as practical training and starting on the NPL goes.

    Additional reviews can then be recorded on tutorial record and uploaded to the communications tab on the NPL, or noted directly onto the communications tab on the NPL.

      

    The practitioner as teacher

    Many of the skills performed by the experienced professional in their daily work, for example, lifting a patient, are largely carried out subconsciously. Because of the amount of practice they have had at performing different procedures, it has become instinctive or internalized (Hinchcliff, 2009).

    Training student veterinary nurses in practice will no doubt involve teaching skills to students. Whilst there may be no question of a qualified professional’s expertise in carrying out different skills, an ability to break down a task into a series of steps or an appreciation of the stages of learning and different learning styles can be a challenge in its own right.

    Breaking down tasks

    If skills can be broken down into a series of steps they are much more easily understood, although there are other factors that need to be considered, for example the level of motivation of the student and how the subject is presented by those teaching it.

    Whether you are a new or experienced clinical coach, the teaching method you select can affect the way in which students learn, so an assessment of each individual student is essential (see previous sections).

    There is an old adage that is well known to those who teach:

    • Tell ‘em what you’re going to tell ‘em
    • Then tell ‘em
    • Then tell ‘em what you’ve just told ‘em

    The sequence of events when developing a student’s clinical skills is therefore:

    1.  The Introduction
    • Explaining how and what you’re going to do, ‘setting the scene’.
    • This may include discussion with the student about what they already know on the subject, and telling them why they need to gain the knowledge and the method by which they are to learn it.
    2.  The progression of subject material
    • Actually doing the task/procedure with the clinical coach first demonstrating whilst the student observes
    • Progressing so that the student demonstrates and the clinical coach observes
    • The student gaining experience and confidence in that task/procedure over time
    3.  The conclusion
    • Assessing the end product each time, and if possible getting the student to reflect on the outcome to benefit their own self development
    • The final conclusion being that the clinical coach can declare competence

    The stages of learning

    More often than not the process of learning will involve making mistakes, and this can be a source of bad feeling for students as they focus on judgements like ‘you’re not doing that right’ and don’t see how they are developing as a result of their mistakes. Models defining the stages of learning a skill can help keep the learning process about learning, and not feeling bad about it.

    The ‘conscious competence’ model of the stages of learning.

    Stage 1: Unconscious incompetence
    • Not being aware of the existence or relevance of the skill area.
    • Not aware of a deficiency in the area concerned.
    • Might deny the relevance or usefulness of the new skill.
    • Must become conscious that they are incompetent in this skill before they can then develop to the next stage.
    Stage 2: Conscious incompetence
    • Awareness of the existence and relevance of the skill.
    • Becomes aware of the deficiency in the skill, ideally by attempting or trying to use the skill.
    • Realisation that improving the skill will improve their effectiveness.
    • Ideally the person has a measure of the level of their deficiency, and a measure of what level of skill is required.
    • A commitment is made to learn and practice the new skill to get to the next stage.
    Stage 3: Conscious competence
    • Achieved when the skill can be performed reliably at will.
    • Concentration and thought is required in order to perform the skill.
    • The skill can be performed without assistance.
    • The skill will not be performed reliably unless it is thought about. It has not yet become ‘second nature’ or ‘automatic’.
    • The skill should continue to be practiced in order to reach the next stage.
    Stage 4: Unconscious competence
    • The skill becomes so practiced that it enters the unconscious parts of the brain.
    • It becomes possible to do the skill whilst also doing something else.
    • It might now be possible to teach this skill to other persons, depending on how instinctual the task has become to them.

    Similarly, Benner’s model of the Stages of Clinical Competence describes development in term of novice, advanced beginner, competent, proficient and expert. However, unlike the conscious competence model, it also promotes the importance of self-reflection in skill development.

    Benner’s Stages of Clinical Competence

    Benner’s application to nursing of the Dreyfus model of skill acquisition:

     The Dreyfus model suggests that in the acquiring and development of a skill, a student passes through five levels of proficiency: novice, advanced beginner, competent, proficient and expert. These different levels reflect changes in three general aspects of skilled performance:

    1. One is a movement from reliance on abstract principles to the use of past concrete experience which can be reflected upon.
    2. The second is a change in the student’s perception of a situation, in which the situation is seen less and less as a collection of complicated bits, and more and more as a complete whole in which only certain parts are relevant.
    3. The third is a passage from detached observation to involved student. The student no longer stands outside the situation but is now engaged in the situation.
    Stage 1: Novice

    Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule governed behaviour typical of the novice is very limited and inflexible. As such, novices have no ‘life experience’ in the application of rules.   ”Just tell me what I need to do and I’ll do it”

    Stage 2: Advanced beginner

    Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have them pointed out to them by a coach, the recurring meaningful situation components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. These principles are based on experience. 

    Stage 3: Competent

    Competence (typified by the nurse who has been doing the job and involved in similar situations for two or three years) develops when the student begins to see his or her actions in terms of long term goals or plans of which he or she is consciously aware. For the competent student, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytical contemplation of the problem. The conscious deliberate planning that is characteristic of this skill level helps achieve efficiency and organisation. The competent student lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with, and manage the many contingencies of clinical nursing. The competent person does not yet have enough experience to recognise a situation in terms of where it fits into an overall picture.

    Stage 4: Proficient

    The proficient performer perceives situations as wholes rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long term goals. The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The proficient nurse can now recognise when the expected normal picture does not materialise. This holistic understanding improves the proficient nurse’s decision making; it becomes less laboured because the nurse now has a perspective on which the many existing attributes and aspects in the present situation are the important ones. The proficient nurse uses maxims as guides which reflect what would appear to the competent or novice performer as unintelligible nuances of the situation; they can mean one thing at one time and quite another thing later. Once one has a deep understanding of the situation overall, however, the maxim provides direction as to what must be taken into account. Maxims reflect nuances of the situation.

    Stage 5: The expert

    The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect his or her understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The expert operates from a deep understanding of the total situation. The chess master, for instance, when asked why he or she made a particularly masterful move, will just say; ‘Because it felt right; it looked good.’ The performer is no longer aware of features and rules; his/her performance becomes fluid and flexible and highly proficient. This is not to say that the expert never uses analytic tools. Highly skilled analytic ability is necessary for those situations with which the nurse has had no previous experience. Analytic tools are also necessary for those times when the expert gets a wrong grasp of the situation and then finds that events and behaviours are not occurring as expected. When alternative perspectives are not available to the clinician, the only way out of a wrong grasp of the problem is by using analytic problem solving.

    How can ‘stages of learning’ be used within the coaching process?

    Quite simply, a student can be asked which stage of learning they feel they are at for particular tasks. Developmental discussion can then focus on what needs to be done to get the student to the next stage. The clinical coach should NOT be telling the student what they need to do to get to the next stage. The role of the coach is to ask appropriate questions that enable the student to identify what they need to do and the help and support they will require to get there. The coach can then assist in facilitating this to allow student development.

    Kolb Learning Cycle

    Another simple, yet useful model for learning is Kolb’s experiential cycle of learning. This focuses on reflecting on experiences in order to develop. Reflection for self- development is an important skill where students have to think for themselves about what they need to do to improve, as opposed to simply being told.

    Kolb Learning Cycle

      

    The debate around learning styles

    Educational research has shown that by becoming more aware of how an individual learns, i.e, how they prefer to receive information, they can become a more efficient and effective learner. There is no one single method of learning; there are many, and what works best depends on the task, the context and the individual’s personality.

    Within adult education, there is a huge amount of theory and instruction material available aimed at helping trainers/educators best meet the educational needs of their students. The term ‘learning styles’ has long been synonymous with this topic.

    Learning styles refers to a range of theories that aim to account for differences in individuals learning, (Coffield, Moseley & Hall, 2004). Although there is ample evidence that individuals express personal preferences for how they prefer to receive information, few studies have found validity in using learning styles in education, (Willingham, Hughes & Dobolyi, 2015).

    Riener and Willingham’s, The Myth of Learning Styles, (2010) argues that there is no credible evidence that learning styles exist. In addition, they argue that learners differ in their ‘abilities, interests, and background knowledge, but not in their learning styles’.

    Other academics, such as Richard Felder, believe that while learning styles do not provide a complete portrait, they can potentially provide an outline or framework. However, addressing learning needs is infinitely more complex than implied by learning styles ideology.

    Learning style theories share the proposition that humans can be classified in terms of their learning style. However, these theories generally differ in how they define, categorise and assess individual learners.

    Take a look at the links to the following popular learning style theories and you can see the similarities and differences in their approaches.

    1. VAK
    1. Kolbs Experiential Cycle of Learning
    1. Honey and Mumford
    1. VARK model

    Coffield, Moseley & Hall, (2004) conducted the study, ‘a critical analysis of learning styles and pedagogy in post 16 learning: a systematic and critical review’. The aim was to carry out an extensive review of research on post 16 learning styles to evaluate the main models of learning styles and to discuss the implications of learning styles for post 16 learners. They wanted to catalogue the best models in the field. The abstract for the study can be found by clicking on the link:

    This study identified an ‘A list’ of learning styles models that were appraised as promising:

    • The Cognitive Style Index of Allinson and Hayes has the best psychometric credentials.
    • Apter reversal theory is a theory of personality, not of learning style. It was included because the concepts of motivation and reversal (e.g., change from work to play) are important for understanding learning styles.
    • Entwistle: his Approaches and Study Skills Inventory for Students (ASSIST) is useful as a sound basis for discussing effective and ineffective strategies for learning and for diagnosing students’ existing approaches, orientations and strategies.
    • Herrmann: his ‘whole brain’ model is suitable for use with learners as well as with teachers and managers, since it is intended to shed light on group dynamics as well as to encourage awareness and understanding of self and others.
    • Jackson: the Learning Styles Profiler (LSP) is a relatively new, but sophisticated, instrument, which has yet to be tested by independent researchers.
    • Vermunt: his Inventory of Learning Styles (ILS) can be safely used in higher education, both to assess approaches to learning reliably and validly, and to discuss with students changes in learning and teaching (2004).

    Apart from the A list, the following are the accepted models with validated instruments that according to Coffield, Moseley & Hall, (2004), “proved to be the most psychometrically sound and ecologically valid”.

    • Allinson and Hayes’ Cognitive Styles Index (CSI)
    • Apter’s Motivational Style Profile (MSP)
    • Dunn and Dunn model and instruments of learning styles
    • Entwistle’s Approaches and Study Skills Inventory for Students (ASSIST)
    • Gregorc’s Mind Styles Model and Style Delineator (GSD)
    • Herrmann’s Brain Dominance Instrument (HBDI)
    • Honey and Mumford’s Learning Styles Questionnaire (LSQ)
    • Jackson’s Learning Styles Profiler (LSP)
    • Kolb’s Learning Style Inventory (LSI)
    • Myers-Briggs Type Indicator (MBTI)
    • Riding’s Cognitive Styles Analysis (CSA)
    • Sternberg’s Thinking Styles Inventory (TSI)
    • Vermunt’s Inventory of Learning Styles (ILS)

    Whilst the above study included extensive research, we must also remember that it is now nearly 20 years old.

    With so many different learning styles models available, where does one start? Numerous questions arise including:

    • Should we even consider learning style models at all as few studies have found validity in using learning styles in education?
    • If yes, which learning styles models should we consider using?
    • How can all this information be simplified to help us help our students?

    What is our experience with learning styles?

    As a research university, we are developing our own evidence base of experiences (both positive and negative) in using learning style theories. Our aim is that clinical coaches can then read through these experiences and potentially employ such theories if they feel these could help their staff and students.

    Generally our clinical placement team have had positive experiences when considering and using learning style theories. We have been able to help students identify, for example, different methods of revising in comparison to their friends. When they understood that they simply took information in, in a different way, and why their friends techniques did not work for them, they were able to feel, and do much better.

    We have also been able to explore learning style theory with practices where it appeared to staff that a student was disinterested in learning compared to other students.

    Take a look at the case examples below.

    Case example one

    A veterinary practice had two HE clinical placement students from the University. We received feedback that student one was really getting ‘stuck in’, joining in at every opportunity and being super involved. In comparison, student two stood back and to other staff appeared disinterested and not really wanting to get involved. Initially staff had thought it was just a confidence issue but as time progressed, there was increasing frustration with student two.

    Using the VAK learning style theory, student one was identified as a kinaesthetic learner - likes touching, feeling, hands on and doing to learn. Student two was identified as a combination of visual learner and auditory learner – so they wanted to observe everything, read about it and listen to what others were doing. Once they had absorbed this information, they then applied this practically.

    Once the team understood this, they adapted how they trained student two and the student flourished.

    Both students achieved skill competence, they just took different routes to achieving this.

    Case example two

    An FE student in one of our affiliated TPs was struggling to pass their theory exams. They were great practically, but were failing their written papers repeatedly. Their educational history showed average grades throughout senior school with no learning difficulties identified.

    Use of Honey and Mumford identified this person as a theorist. The clinical coach and practice team (who were very keen to support this person, due to their excellent practical skills), were advised to explain in more detail when helping with revision, and explain the 'whys' when linking cases to theory. 

    It turns out that this student was trying to memorise facts without understanding 'why'. They were spending hours revising, and making notes, (because that's what everyone else was doing), but the information was not going in or being retained. 

    At first the practice thought the IQAV was crazy, asking them to give a struggling student more information. However, it soon became apparent that once the student understood 'why', the information was retained. The student had failed an exam on the endocrine system. The next day a diabetic cat came in. The vet went through the visuals of the cat, the lab results and how the entire diabetic picture fit together. This way of explaining really helped, and the student went on to pass every other exam. This student was trying to memorise, without understanding, and needed more detail than what she was being provided with. She was trying to revise like 'everyone' else, but this didn't work for her. No-one had explained that there are different ways to revise and learn.

    Conclusions and recommendations

    As detailed in this section, there is ongoing debate as to the usefulness of employing learning style theories. However, our experiences have generally been very positive and have helped students understand themselves, and trainers understand their students in order to motivate and support them.

    It is generally accepted that whilst in our younger years, we may lean towards one particular learning style. As we get older, our lifestyle and experiences increase, and therefore so does how we learn. More often than not, a learning style theory assessment will identify that we use a number of learning styles, not just one or two. That said, sometimes this is not the case, and one may be particularly dominant.

    As discussed, there are a huge number of different learning style theories available. We have placed links to the ones which we have used before which you are welcome to access. Prior to students going into clinical placement, we encourage them to consider learning styles and if they might be appropriate in helping their development. We build this into our ‘student and clinical coach NPL induction and planning tool’ as we would always recommend discussions with students about how they think they learn best.

    Our clinical placement team and the wider university are always on hand to support you and your students so please don’t hesitate to contact us if you wish to discuss this further.

     

      

    Popular models of coaching

    There are numerous coaching models available to assist the coach in coaching students to achieve their goals. The primary focus is getting the student to identify their own goals (both long and short term) and what they need to be doing to ultimately achieve these, with the coach having an influence through the asking of relevant and thought-provoking questions.

    There is no ‘one size fits all’ coaching model. Many clinical coaches will already be using elements of different coaching models without even knowing it, as coaching generally involves a common-sense approach to training.

    If you dared to google, you would find there are literally hundreds of different coaching models available. We have included two of the most popular in this handbook. Why not try these out and then make comparisons to how you would normally approach a student progress review. The results may surprise you!

    OSKAR Model

    OSKAR is a framework for solution focused coaching; it has proved a versatile and flexible guideline for independent coaches as well as managers working as coaches. It is used in face to face and telephone coaching.

    OSKAR is an acronym, standing for Outcome, Scaling, Know-how, Affirm and Action and Review. When OSKAR is used as a process, we start with outcome. This is the part of the discussion where the clinical coach discovers what the student wants. The coaching session then follows the sequence of OSKAR, with the student identifying not only what they want to get out of the coaching programme as a whole, but also what they want out of the individual meeting.

    1. Outcome
    • What is the objective of this coaching?
    • What do you want to achieve today?
    • What do you want to achieve in the long term?
    • How will you know this coaching has been of use to you?
    2. Scaling
    • On a scale of 1-5 (1 being a novice and 5 being an expert) where would you put yourself today?
    • How did you get to this stage?
    • How will you know when you have reached the next stage?
    3. Know-how
    • What factors help you perform better?
    • When does the outcome already happen for you – even a little bit?
    • What did you do to make that happen? How did you do that?
    • What did you do differently?
    4. Affirm and Action
    • What is already going well?
    • What is the next step?
    • What would you like to do personally straight away?
    5. Review
    • What is better?
    • What did you do to make that change happen?
    • What effects have the changes had?

    In short, the clinical coach asks questions to create a sense of possibility and capability.

    In the OSKAR process, a good time to reflect experience and qualities back to the student is immediately before asking what action they might take to get closer to their outcome. Hearing about one’s relevant, successful experiences and resourceful qualities seems as good a preparation as any for selecting a useful next step. The coach then summarise what has impressed them so far, then invite the student to select a small action. This is something for the student to do personally, and is usually expressed as something they might do to take them further towards their ultimate goal, e.g. develop a particular skill.

    The choice of the next step is with the student, not with the coach, though the coach will have an influence on the choice. Once the student has a clear sense of what they want to do (or look out for), the main purpose of the coaching session has been achieved.

    The GROW model

    GROW is one of the most widely known and used coaching models. It is easily understood, straight forward to apply and very thorough. It can also be applied to a range of issues in an effective way.

    The process involves asking questions and actively listening through the application of: Goals, Reality, Options, Will

    GROW model

    Useful questions to consider asking:

    Goals
    • What is the aim of the discussion?
    • What do you want to achieve long term?
    • How much personal control or influence do you have over your goal?
    • What would be a milestone on the way?
    • When do you want to achieve it by?
    • Is that positive, challenging and attainable?
    • How will you measure it?
    Reality
    • What is happening now? (What, when, where, how much, how often)
    • What is involved directly and indirectly?
    • What things are going badly on this issue?
    • What happens to others directly involved?
    • What is the effect on others?
    • What have you done about this so far?
    • What results did that produce?
    • What is holding you back from finding a way forward?
    • What is really going on? (intuition)
    Options
    • What options do you have?
    • What else could you do?
    • What if? (time, power, money etc)
    • Would you like another suggestion?
    • What are the benefits of each?
    Will
    • Which option(s) do you choose?
    • To what extent does this meet your objectives?
    • What are your criteria and measurement for success?
    • When precisely are you going to start and finish each action step?
    • What could arise to hinder you in taking these steps?
    • What personal resistance do you have, if any, to taking these steps?
    • What will you do to eliminate these internal/external factors?
    • Who needs to know what your plans are?
    • What support do you need and from whom?
    • What will you do to obtain that support and when?
    • What could I do to support you?
    • What commitment on a scale of 1-10 do you have taking these agreed actions?
    • What prevents this from being a 10?
    • What could you do or alter to raise your commitment closer to 10?
    • Is there anything else you’d like to talk about?

     

      

    Giving effective feedback

    Feedback is a vital part of education and training. If this is carried out well it helps motivate and develop students’ knowledge, skills and behaviours. It helps students to maximise their potential and professional development at different stages of training, raise their awareness of strengths and areas for improvement, and identify actions to be taken to improve performance.

    If this is carried our poorly, or not at all, the student might assume that there are no areas for improvement or development.

    On occasions, we also see the situation where constructive criticism is not fed back in a timely manner to the student, meaning that they can be doing something incorrect for a period of time annoying people without even knowing it. This can then escalate into an unpleasant and unnecessary situation which could have been resolved from the outset by effective feedback when it was initially needed.

    In practice, many staff are often involved in training a student. Students can get confused and frustrated when they receive different feedback from different staff members about the same issue/task. This is something for clinical coaches to be aware of and assist in standardisation where necessary.

    Good communication is absolutely essential.

    Many clinical situations involve the integration of knowledge, behaviours and skills in complex and often stressful environments with time and service pressures on both the clinical coach and the student. Feedback is central to developing students’ competence and confidence at all stages of their careers, with the most effective feedback being that based on observable behaviours, (Gordon, 2003).

    Regardless of the type of feedback to be given, this needs to be done sensitively and appropriately. A supportive, empathetic and consistent environment and a working relationship based on mutual respect is the basis for enabling feedback to be the most effective and helps the student take responsibility for development and improvement.

    Barriers to giving effective feedback

    Hesketh and Laidlaw (2002) identify a number of barriers to giving effective feedback in the context of ‘medical’ education:

    • A fear of upsetting the student or damaging the coach-student relationship
    • A fear of doing more harm than good
    • The student being resistant or defensive when receiving criticism
    • Feedback being too generalised and not related to specific facts or observations
    • Feedback not giving guidance for how to rectify the situation (if the student has been unable to identify this themselves)
    • Inconsistent feedback from multiple sources

    Considerations for giving effective feedback

    How often should feedback be given?

    Feedback should be given as regularly as possible. This might include every day informal feedback, backed up by more formal progress reviews on a weekly/bi-weekly basis.

    Where will feedback be given? 

    An audience is not ideal especially if there is a need to provide constructive criticism. If something serious occurs that you need to feedback on immediately, is there a consultation room free that can be used?

    The tone of delivery? 

    Shouting rarely achieves anything and will likely just damage your relationship with the student making them fearful of approaching you in the future.

    The student’s role in feedback? 

    Remember that self-reflection is key to student development. Perhaps ask the student to self-assess before discussing your own observations and feedback. Make it a two way process to ensure you both understand each other’s point of view.

    The sandwich approach

    Not always possible, but aim to start and end on a positive note with any criticisms in the middle.

     

      

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