This clinical teaching tool is based on research from the 1980s, with the finding that specific feedback should be directly related to performance. Feedback has three functions:
- Reinforce the learner
- Inform the learner of a way to improve the skill
- Motivate the Learner (Docheff, 1990)
The most useful feedback includes both general and specific information. The idea of the sandwich is to include all three functions of effective feedback - i.e., add a little meat to the sandwich! One of the University of Minnesota family practice physicians found the feedback sandwich particularly useful because it was a short and easy way to provide immediate feedback when working with students in a clinical setting. Their family practice students became so accustomed to this feedback method that they would ask for their "sandwich" after they had completed their visit!
Here's how it works:
The "sandwich" describes the process of reinforcing the learner with a positive comment, followed by a specific constructive suggestion on how to improve, ending with another positive comment or motivational comment. The constructive comment is "sandwiched" between two positive remarks, making the feedback more positive and "digestible" or "palatable." The goal is to provide feedback in a constructive manner that builds on student strengths, while continuing to improve skills and overall performance.
Following is an example of a feedback sandwich. This might be a beginning level student who just performed an annual well woman exam. The preceptor validates the aspects of the visit that the student did well (interview skills, compassion), and then provides specific ideas about the areas that need improvement (speculum insertion, tuning in to client cues). Then the preceptor reinforces the contributions the student made (compassion toward the patient). As you can see, this kind of feedback is immediate, short, and communicated in a positive manner.
Reinforce: I am very impressed with the thoroughness of your patient history. You are coming in with some very strong interviewing skills.
Inform: You need to work on your foley catheter insertion. This patient was very tense and needed some help relaxing before the procedure.
Motivate: I can tell that you really care about making the client comfortable.
Specific feedback is best when planned for, so before precepting a student for a specific skill, think about the elements you will be watching for, so you can plan your feedback as a sandwich. You will find your students asking for the "sandwich" as well!
- Sage, G. H. (1984). Motor learning and control - A neuropsychological approach. Dubuque, IA: Wm. C. Brown.
- Docheff, D. M. (1990). The Feedback Sandwich. Journal of Physical Education, Recreation and Dance. v. 61 (Nov./Dec. 1990), p. 17-18.