Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11FEEDBACK TOOL-KIT Advocacy-Enquiry Model The Advocacy-Enquiry model is used as a debriefing tool in simulated learning environments. Feedback and debriefing are similar in that both require two-way dialogue between the supervisor and learner, but feedback is largely related to improving performance and debriefing is largely related to promoting understanding. Advocacy aims to create shared understanding and direction, turn words and ideas into coordinated action, and move collective thinking forward. Enquiry, as an adjunct to advocacy, is a method of engagement. Attentiveness and curiosity, along with active listening, are important tools for effective enquiry. Advocacy- Enquiry model Process: Advocacy-Enquiry Example  Uncover ideas and thought processes that lead to a behaviour  Help the learner find ways to improve performance Observe an event or result Comment on the observation Advocate for your position Explore the drivers behind the learners thinking (their frames*) and actions that they think lead to the observed event or result Discover with the learner/s ways to address issues that arose and ways to replicate positive results A supervisor was providing feedback to a trainee on their performance in management of trauma resuscitation. The supervisor noted that the trainee repeatedly prioritises a CT scan of the head above other imaging in trauma patients, whilst more senior clinicians thought CT was contraindicated because of patient instability. Whilst enquiring about the reasons for wanting a CT scan of the head early in the assessment the trainee commented that hypotension could be caused by blood loss into the head. (This is fundamentally incorrect as the amount of blood lost in an intracranial injury is never enough to cause hypotension alone. Other blood loss must occur concurrently.) The trainee also commented that they were concerned about initiating life support in patients with high chances of brain injury and resultant poor quality of life outcomes. As a result of understanding the trainee’s ‘frame’*, the supervisor was able to correct a knowledge gap regarding hypotension and intracranial injury and explore an attitude that was impacting on the trainee’s behaviour. This highlights why shared understanding is critical for performance management. Frames* are in the minds of the learner and supervisor. They include assumptions, feelings, goals, knowledge, situational awareness and context. Weblinks and references to resources about models of feedback: http://www.axialent.com/pdf/Advocacy_and_Inquiry_by_Fred_Kofman.pdf http://www.hserc.ualberta.ca/en/TeachingandLearning/VIPER/EducatorResources/AdvocacyInquiry.aspx http://www.gp-training.net/training/educational_theory/feedback/pendleton.htm http://gp-training.net/training/communication_skills/calgary/agenda.htm#method http://gp-training.net/training/communication_skills/calgary/climate.htm Rudolph et al (2006) Debriefing with Good Judgement: Combining Rigorous Feedback with Genuine Inquiry, Journal for the Society for Simulation in Health Care; 1(1)49-55 Vickery & Lake (2005) http://www.meddent.uwa.edu.au/teaching/on-the-run/tips/?a=99373