Friday, August 17, 2012

What medical educators can learn from the car industry

Formative and Summative Feedback

Formative feedback - that is the ongoing, near real time, specific, non judgmental feedbak - is critical to learning and helping change behavior [Ref].  Unfortunately medical educators have for too long used only summative feedback for assessing medical students - you know the end of rotation grades, the USMLE scores etc.

Part of the problem is that faculty and preceptors are the ones who need to provide this feedback as they work with students on a daily basis.  But they are unaware of the need for such feedback or are not trained to provide it or unable to provide it for logistic reasons.  Clerkship directors meet with the students only infrequently and do not have such feedback to review and share with the students.  They often have comments like "Excellent" or "Great presentation" or "needs to work on presentation skills" which is not specific or helpful.

How can we train our faculty in giving useful formative feedback? Since most faculty members went through traditional medical school programs and did not receive much formative feedback, they may not be aware of what it is and the importance of giving this.  A metaphor we can use is something we see almost daily and comes from the car industry.  [For some interesting reading on this see the National Renewable Energy Laboratory Report (pdf) by Gonder et al]

Learning Objective: Learn to drive in a way that improves fuel efficiency.

Cars now give immediate and constant feedback to the driver regarding the rate of fuel consumption as miles per gallon.  This is visible on a visual scale next to the odometer.  It also shows a color indication in a ring around the speedometer (e.g. green if driving at optimal speed and acceleration).   This is an excellent example of formative feedback and can lead to correction in behavior.

Cars also provide an average fuel consumption for a particular duration, and can be reset by the user.  In most cases it is reset on refilling the fuel tank.  Looking at this at the time of refueling gives the driver summative feedback on their performance for that duration.  If the number is low, it should not come as a surprise to the driver who has been getting constant feedback and has failed to change behavior.  The driver has control over how she/he chooses to drive.

While drivers can choose to ignore the feedback, in case of students, they come to a medical school to become good physicians.  They want to get such feedback and to constantly improve.  Using this metaphor hopefully we can train our faculty to provide more useful, timely, non judgmental feedback.  One hopes this will lead to them spending more time in helping all our students become better physicians and less time comparing and ranking them.

If the car industry can understand this, why not medical educators?