Pendleton's rules

At the recent ATLS National Day and the Europen meeting of ATLS Educators there were discussions about other courses trying out different approaches to feedback. It seems as though Pendleton's rules for feedback http://www.gp-training.net/training/educational_theory/feedback/pendleton.htm are falling out of favour.

I was asked why this may be the case, and my personal view is that it is not the Pendleton framework which is at fault, but the struggle many people have to either understand the point of Pendleton, or to conduct a developmental conversation that is both specific, based on behavioural evidence and sufficiently constructive.

I have discussed various forms of feedback on here previously (see DEBRIEF), but wanted to make out a case for the use of Pendleton's rules.

For me the benefit of Pendleton is that it reaches all stages of learning, from the competent to the incompetent, and from that which we are aware of to that which we are not aware of.

As I have written before, learning is a matter of developing both competence and conscious awareness. We progress from a state of not knowing that we do not know or cannot do (unconscious incompetence) through the stage of being aware of what we do not know or cannot do (conscious incompetence) to one of knowing what we know and can do (conscious competence) to the final stage of knowing what we know and doing what we do but not being always aware of that (unconscious competence.)

If this is the case, and this learning curve describes the rudimentary stages we progress through when learning a new skill or behaviour, then feedback needs to access each of these stages of learning.

Pendleton's rules map onto these stages of learning beautifully:

1. Asking "What went well with that?" accesses the conscious competence quadrant and focuses the learner's mind on practice that needs to be repeated in future. This question also allows for the teacher to assess the levels of insight the learner displays, in their self evaluation.

2. Providing further discussion of what went well led by the teacher, develops the good practice and may access the areas of strength which the learner has no awareness of (unconsciously competent.)

3. Asking the learner what they were less pleased with and what could be developed further, also checks insight levels, and accesses the consciously incompetent areas of practice.

4. Finally, discussing with the learner what the teacher feels needs to be developed (with an action plan to do so) accesses the unconsciously incompetent quadrant.

Pendleton offers a framework within which we can discuss all aspects of the learning curve, including those areas of competence and incompetence known and unknown to the learner. What we need to do within each of the four questions advocated by Pendleton is to be specific about the strengths and areas for development, not shy away from being honest in our descriptions of the behaviours we have observed. And we must always encourage further actions which develop the weaker areas.

Proof it can be done!

A great new article from a trainee who was victim to the curriculum changes from BST to ISCP.

This article shows how hard Rafay worked and what he has achieved. He is now deservedly in ST3 training in the specialty of his choice.

http://careers.bmj.com/careers/advice/view-article.html?id=20002902