NU676 Unit 5 Feedback Reflection Through Kolb Example

"That's a Menu, Not a Recommendation": A Feedback Reflection Through Kolb's Four Stages

[Student Name]

Purdue University Global

NU676: PMHNP Diagnosis and Management Across the Lifespan Clinical II

Unit 5 Feedback Reflection

[Instructor Name]

[Date]

The preceptor and patient are composite; details are bracketed.

Concrete Experience

In week [five] I presented Ms. [D.], a [36]-year-old office manager with panic disorder, three panic attacks a week and avoidance of driving on the highway. After a thorough history I said: "Options include starting sertraline, referring for cognitive behavioral therapy, or both." My preceptor waited, then said, "That's a menu, not a recommendation. Which would you choose, and why?" I said I thought both were reasonable. She said, "They are. That's why the patient needs you to pick one and tell her why." She then made the decision herself: a referral for cognitive behavioral therapy and sertraline, with a plan to review in six weeks.

My face went hot. I said very little for the rest of that clinic.

Reflective Observation

Looking back, three things stand out. First, I had the information to make a recommendation. Ms. [D.] preferred to avoid medication if possible, had strong insurance coverage for therapy, and had no depression. Those facts pointed toward starting with therapy. Second, I was not uncertain about the options; I was uncertain about being wrong. Listing options felt safer than choosing one. Third, the feedback was specific and immediate, which is why it stung, and also why it was useful.

Feedback in clinical education works best when it is specific, based on observed behavior and given close to the event, and when it is framed as information for improvement rather than judgment (Ende, 1983). My preceptor's comment met all of those conditions.

Abstract Conceptualization

Reading on feedback helped me understand why the comment worked. Hattie and Timperley argue that useful feedback tells learners what the goal is, how far their work is from it, and what to do next, and they found that feedback about the task and the process is more effective than feedback about the person (Hattie & Timperley, 2007). The comment answered all three: the goal was a recommendation, I had given a list, and the next step was to choose.

The deeper concept I took from it is that a recommendation is not a claim of certainty. It is a judgment offered with reasons, which the patient and preceptor can then accept or change. Offering a menu felt humble, but it handed the hardest part of the work back to the people I was supposed to help.

Active Experimentation

I set myself a rule for the rest of the rotation: in every presentation where more than one option is reasonable, I will state one recommendation and the reason, then mention the alternative. I kept a tally over the next [eleven] presentations in which there was more than one reasonable option.

1. Recommendation stated with a reason: [nine] of [eleven].

2. Preceptor agreed: [six]; modified: [two]; disagreed: [one].

3. Presentations in which I slipped back into a list: [two], both in the first week after the feedback, both when I was tired at the end of the day.

When my preceptor disagreed, she explained why, and I learned more from that exchange than from any of the agreements. That was the part I had been avoiding.

What Changed and What Did Not

The habit held in most presentations. It did not hold when I was tired, which tells me it is not yet automatic. Kolb described learning as a cycle in which experience, reflection, conceptualization and experimentation feed one another, with each new experiment becoming the next experience (Kolb, 1984). My next cycle begins with the two slips: I plan to write my recommendation in my note before I present, so that fatigue does not decide for me.

What I Noticed About the Sting

It is worth being honest about why a mild, accurate comment stung as much as it did. My first rotation had rewarded thoroughness, and I had come to see complete lists as a sign of competence. Being told that the list was not enough felt, for an afternoon, like being told that the competence I had built did not count. That reaction was out of proportion to the comment, and recognizing that helped me use it. I also noticed that I had been quietly waiting for my preceptor to model the decision so that I could copy it, which kept me safe but kept me a reporter. The discomfort of committing to a choice turned out to be smaller than the discomfort I had imagined, and it faded after the first few presentations in which my recommendation was accepted or corrected without any drama.

What I Would Say to a Classmate

If a preceptor calls your presentation a menu, the problem is rarely lack of knowledge. It is usually reluctance to risk being wrong. Choose, give your reason, and let the preceptor correct you; the correction is the teaching.

References

Ende, J. (1983). Feedback in clinical medical education. JAMA, 250(6), 777-781. https://doi.org/10.1001/jama.1983.03340060055026

Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81-112. https://doi.org/10.3102/003465430298487

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice-Hall.