Delivering Feedback with L.O.V.E. A perspective on learner-centered feedback using emotive language.

Author

Ras Mulinta, B.Ed.,Ph.D. Physiology (biography and disclosures)
Disclosures: Nothing to disclose.

What I did before:

Delivering constructive feedback was challenging for me, particularly in the context of Respect Equity Diversity and Inclusion (REDI) awareness¹.  The pressure to keep up was overwhelming and I experienced cognitive burnout. Frequently, I feared being perceived as insensitive or overly critical when providing feedback and had used the sandwich technique², which involves providing a compliment, followed by the feedback, and concluding with another compliment. While this technique is effective in softening the blow of criticism², it often felt insincere, as though I was merely cushioning the feedback with compliments, rather than fostering intrinsic motivation³ to pursue self-learning and deeper scholarly engagement.

I noticed that while students would initially do as per my recommendations, the behavior change nor desire to change did not last. I realized that while the sandwich technique is intended to be constructive, the narrative is often subjective to biases, hidden curriculum⁴ and can be perceived as meaningless and detrimental when delivered without emotional consideration^5,6. This may inadvertently reinforce the mechanistic and de-humanizing nature of medical education⁷, where emotive practices, such as the use of inclusive language⁶, are often neglected, particularly in a population prone to machine-like perfectionism⁸ and imposter syndrome⁹.

Consequently, I frequently considered how to integrate a more genuine emotional connection (affect) and constructive (effect) feedback, into my existing practice.

What changed my teaching practice:

To learn about student-centred teaching, I took a sabbatical at the Faculty of Education in 2019-2020, and recently, a mini sabbatical at Center for Health Education Scholarship (CHES) at UBC. During these periods, I engaged in discussions on various aspects of education and scholarship, with a particular focus on the anatomy of trust¹⁰ in the student-teacher relationship. A teacher’s active reflection¹¹and sense of self^11,12, were identified as critical components for co-creating a classroom environment that fosters REDI principles¹.

Additionally, I learned from scholars at CHES that the healthier the educational alliance between teacher and student, the more effectively students incorporate preceptors’ feedback¹³.

Two other educators were also very impactful to me: UBC professor of teaching Peter Arthur, known for his Pedagogy of Care¹⁴, and retired school principal Mrs. Alida Privett, who emphasized relationship building based on: listening, overlooking minor issues, asking challenging questions, and doing everything with love.

Inspired by these educators and scholars, and driven by curiosity about the role of care and love in education, I developed an approach to teaching and called it: L.O.V.E¹⁵.

What I do now:

I have been practicing L.O.V.E in the last five years and I have noticed that learners are more receptive to the feedback and their changes more sustained. The process is as follows:

1. Listening – I prioritize active listening by engaging each student in a critical evaluation of the objectives/exit competencies or other list of criteria relevant to the learning experience. I encourage them to identify and share their areas of strength and those requiring further development, early in our interactions. This step is learner centered and collaborative goal setting¹⁶ in the context of educational alliance¹³. It is the most challenging step in my practice as I unlearn my bias towards didactic lecturing.

2. Observing – Throughout our interactions, I observe the students’ behaviors and document their performance and progress over time, and when possible, over different courses, anchored by the criteria they have chosen to focus on. This step is the most laborious in my practice.

3. Validating – I frequently acknowledge and validate their efforts with clarifying questions through employing role model and coaching strategy¹⁷. This step is designed to foster active reflection, enhance critical thinking, and stimulate intrinsic motivation³.  In my practice, I experience joy, purpose and fulfillment in this step.

4. Empathizing – During our interactions, I empathize with their efforts and connect with their experiences by using I-statements¹⁸, while focusing on their areas of strength to cocreate solutions rather than succumbing to my bias to lecture. In my practice, this step is crucial for building empathy and relational rapport though mutual understanding.

In narrative feedback, my response now incorporates emotive language of encouragement to pursue self-learning, deeper scholarly engagement and a personalized learning plan (PLP):

“Thank you (L & E) for identifying and sharing with me that communication skills are an area for improvement, particularly summarizing relevant case information using structured approach (L & E). I appreciate (E) your efforts to unpack difficult concepts onto the whiteboard during class (O). I noticed that while layperson language was used effectively (O & V), some terms were not clearly understood, and there wasn’t an opportunity for clarification (O). How can we incorporate space and time into the communication process for better engagement next time? (V, E & PLP)”

How my experience is relevant to teachers in the Faculty of Medicine:

Reflecting on my experience, I recognize that chronic stress and burnout are significant challenges in medical education, and that I was not alone in experiencing cognitive burnout⁷.  I think practicing a learner centered approach to teaching, such as L.O.V.E., alongside existing approaches, has the potential to provide some emotive support and relieve from that burnout for others, as it has for me.  I remain curious about its potential transformative impact on humanizing medical education and plan to continue to study this approach.

In the paper Stress contagion in the classroom? on supporting the importance of teachers’ wellbeing, UBC Social Emotional Lab’s researcher Kimberley Schonert-Reichl aptly states: “It is clear from a number of recent research studies that teaching is one of the most stressful professions, and that teachers need adequate resources and support in their jobs in order to battle burnout and alleviate stress in the classroom. If we do not support teachers, we risk the collateral damage of students.”¹⁹ And may I add, patients’ wellbeing too.

References & Acknowledgements:

1. UBC Faculty of Medicine REDI principles. Current. https://redi.med.ubc.ca/#:~:text=The%20Office%20of%20Respectful%20Environments,racism%2C%20and%20anti%2Ddiscrimination.
2. Dohrenwend. 2002. Serving Up the Feedback Sandwich. Fam Pract Manag.; 9(10):43-46. https://www.aafp.org/pubs/fpm/issues/2002/1100/p43.html
   
3. Armstrong. 2013. Use exams to guide, not drive, learning; the importance of intrinsic motivation. UBC Faculty of Medicine, This Changed My Practice. https://thischangedmypractice.com/use-exams-to-guide-not-drive-learning-the-importance-of-intrinsic-motivation/
4. Holmes. 2019. Addressing the Hidden Curriculum at UBC. https://med-fom-ubcmj.sites.olt.ubc.ca/files/2019/03/Feature-1.pdf
5. Shafian et al. 2024. The feedback dilemma in medical education: insights from medical residents’ perspectives. BMC Medical Education. Article number: 424. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05398-y
6. Martimianakis and M. D’Eon. 2021. Coming to terms with the languages we use in medical education: hidden meanings and unintended consequences. Canadian Medical Education Journal. 12(2):e1-e8. https://www.researchgate.net/publication/351733129_Coming_to_terms_with_the_languages_we_use_in_medical_education_hidden_meanings_and_unintended_consequences
7. J. Hoogendoorn et al. 2023. Rethinking dehumanization, empathy, and burnout in healthcare contexts. Current Opinion in Behavioral Sciences. V52: 101285. https://www.sciencedirect.com/science/article/abs/pii/S2352154623000396
8. Elay et al. Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students. Medical Teacher. p1301-1307. https://www.tandfonline.com/doi/full/10.1080/0142159X.2020.1805101
9. Baumann et al. Small-Group Discussion Sessions on Imposter Syndrome. The Journal of Teaching and Resources. Open Access. https://www.mededportal.org/doi/10.15766/mep_2374-8265.11004
10. Brown. 2018. Dare to Lead; Anatomy of Trust.
11. Freire. 1970. Pedagogy of the Oppressed. Continuum.
12. Palmer. 2007. The Courage to Teach: Exploring the Inner Landscapes of a Teacher’s Life. San Francisco, CA: Wiley.
13. Telio, R. Ajjawi and G. Regehr. 2015. The “educational alliance” as a framework for reconceptualizing feedback in medical education. Academic Medicine. 1;90(5):609-614. https://journals.lww.com/academicmedicine/abstract/2015/05000/the__educational_alliance__as_a_framework_for.21.aspx
14. Arthur. 6 steps of Instructional Design & Pedagogy of Care. Okanagan School of Education. https://ctl.ok.ubc.ca/awards/fellows/peter-arthur/
15. Mulinta. 2024. Delivering Feedback with L.O.V.E. A perspective on learner-centered feedback using emotive language. This Changed My Teaching. University of British Columbia.
16. L. et. al. 2019. Your Goals, My Goals, Our Goals: The Complexity of Coconstructing Goals with Learners in Medical Education. Teaching and Learning in Medicine. V31, Issue 4: 370-377.
17. Price et al. 2021. Coaching the coaches: Employing role modeling and coaching as a faculty development strategy. Medical Teacher. Vol.43. Issue 8:918-919. https://www.tandfonline.com/doi/full/10.1080/0142159X.2021.1929908?scroll=top&needAccess=true#d1e180
18. I-statements. 2011. Boston Faculty of Medicine. https://www.bumc.bu.edu/facdev-medicine/files/2011/08/I-messages-handout.pdf
19. Oberle and K. A. Schonert-Reichl. 2016. Stress contagion in the classroom? The link between classroom teacher burnout and morning cortisol in elementary school students. Soc Sci Med.: 159. p30-7. https://pubmed.ncbi.nlm.nih.gov/27156042/

Vote

Please indicate how this article will change your practice:

Delivering Feedback with L.O.V.E. A perspective on learner-centered feedback using emotive language.

• I disagree with this approach
• I will consider changing my practice, but need more information/time
• I will likely change my practice
• I will definitely change my practice
• I already do this

View Results

 Loading ...