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Good, Better, How: Feedback for Med Student Success

UNLV School of Medicine’s approach counters fear to stimulate growth in both students and faculty.

Campus News  |  Nov 8, 2016  |  By Ed Ort
Mark Guadagnoli speaks to students

Mark Guadagnoli, director of learning and performance at UNLV School of Medicine, discusses its method for giving feedback to students with colleagues. (Josh Hawkins/UNLV Photo Services)

All too often, Mark Guadagnoli has seen this scene play out: A faculty member notices a first-year student is not keeping up with the material. She calls the student in for a talk, complete with the standard advice. Work harder. Study more. The path you’re on might lead to failing. Such warnings typically serve as short-term motivation, but generally creates a fear-based relationship that actually reduces the student's motivation in the long term.

Guadagnoli, director of learning and performance at UNLV School of Medicine, says there is a better way, or rather, a “Good, Better, How" way.

He has seen this feedback technique work wonders in academic, business, and athletics. Though the approach is simple in design, he says, it has a strong science foundation, and most important, gets results. 

“The science is very clear that feedback is critically important for consistent improvement, but not all feedback is equal,” Guadagnoli says. “If feedback is done right, it not only helps a person to improve, it also can builds strong relationships.

The approach begins by identifying what’s good about a situation. “That’s important,” says Guadagnoli, “because it counters people’s inherent fear of receiving negative feedback. Acknowledging the ‘good’ of a person’s performance is important because this tends to motivate the person to continue the behavior. If all we look at is the negative or what needs to be improved, that's all we're going to see. That can overwhelm the student, making it hard to focus on how to change the path. In the long run, this can increase stress and burnout.”

This dynamic is no fun for the giver of feedback, either, he notes. “They feel like they're constantly delivering bad news. Good, Better, How provides an avenue for building on the positive. It changes the feedback dynamic to something that's more growth oriented. As a result, feedback can happen more frequently and more successfully.”

The second phase asks the question, “Objectively, what could be better?”

“When you ask this question, you’re really thinking about it from a solution-based perspective. You've already established that there is good to build on, now what's next? What could you do better? How could you do it differently?”

The “How” phase requires a specific improvement plan. The approach identifies a tangible solution rather than simply identifying problems, Guadagnoli says. “You are driving to a concrete solution, that includes achievable milestones and a realistic timeframe for completion. The ‘how’ portion creates accountability.”

A Focus on Relationships

The Good, Better, How approach builds a trusting relationship between individuals. Dr. Ellen Cosgrove, vice dean for academic affairs and education, points out that feedback is taken more seriously if the relationship between the giver and the receiver is built on trust. Both parties are working together toward improvement.

Starting the conversation with agreement on what is good helps both parties focus the success of the student. “You want to ensure the student is not bracing for you to zap him with what you think he did wrong, but rather sees you are genuinely interested in eliciting what the student thinks he did well and what the student thinks he could improve.”

Cosgrove sees the Good, Better, How approach as being in tune with the overall goals of the medical school. “The approach fits nicely with the culture that we're trying to create within the medical school of building long-term relationships between the faculty and students.”

What’s more, she said, it establishes a model for practicing medicine long after graduation. “It sets the stage for healthy and more constructive, nonjudgmental relationships with patients, where the physician helps patients identify their goals and how they want to make change.”