Tuesday, April 28, 2009

Crap sandwiches

Thinking through the last post, I realised I'd put up some received wisdom on the good old hamburger approach to providing feedback without backing it up with facts. In the spirit of evidence based medicine, to discover whether the crap sandwich is as crap as I thought, or not, I did a quick scout around to see what the world's great thinkers in feedback provision are saying. Caveat: very quick scout about.

A group called Success Strategies, who look like they are a group of management consultants of some kind, post an interesting discussion on the method. Their key issues are that:

(i) most people know about this method, brace themselves for the crap in the middle and discount / ignore the rest, and
(ii) it only takes a couple of rides on the crap sandwich rollercoaster to learn exactly how it works and react as for (i).

This page also provides an alternate method which avoids direct criticism and instead kicks the discussion off with suggestions of how to deal with the situation which went awry. Interesting.

Although this approach is grounded in NLP, which some consider pseudoscience (it says here - although it seems to work for Derren Brown), this group have worked with some creditable organisations which provides a degree of weight to their work.

A literature search brings up little on the subject... perhaps a fruitful research topic for someone, who knows. The search did, however, bring up an excellent article from a US Obs&Gynae educational committee of some sort describing in detail how the US is approaching the provision of feedback to medical undergrads. They outline a quite structured, complex process which necessitates a dialogue and a lot of preparation with no input from peers... quite the opposite to what Australian med schools seem be recommending. Given the lack of outcome evidence (from what I can see), who knows which approach is best.

The reference for this, should anyone be interested, is: American Journal of Obstetrics and Gynecology (2007). 196 (6). 508 -513. I think it may be available if you register, but it's an Elsevier journal so perhaps not.

On balance, I would still say the crap sandwich is on the nose. Avoid.

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