The Rightful Demise of the Sh*t Sandwich: Providing Effective Feedback.
BACKGROUND
As a trainee cognitive therapist in the early 1990s, I was taught the Sh*t Sandwich by my supervisor. I continued to use this technique for many years without seeing the need to extend my repertoire of feedback strategies.


OBJECTIVE
This article describes a number of other feedback techniques, raising awareness of the processes underpinning feedback, and facilitating reflection on feedback methods.


METHODS
This review examines feedback and the methods of feedback used to improve clinical competence.


RESULTS
Evidence informs us that the use of good feedback has a significant effect on learners' outcomes (Milne, 2009). However, despite recognition of its importance, many supervisors fail to give adequate feedback and utilize methods that are sub-optimal. One such problematic method is the notorious "Sh*t Sandwich" (SS), which attempts to hide criticism within a cushion of two positive statements. This paper looks at various models of giving negative and positive feedback, suggesting that our repertoire of feedback methods may require expanding.


CONCLUSIONS
The review suggests that feedback is a complex process and methods that place an emphasis on the learner as an active participant in the learning process (i.e. interactive approaches) should be encouraged. The paper suggests that negative feedback should generally be avoided in favour of constructive support, accompanied by specific, descriptive, balanced feedback, with new learning being consolidated by role play. Generally, feedback should be given about the task rather than the person, but when it is personalized it should relate to effort rather than ability.
NTW NHS Foundation Trust, andNorthumbria University,Newcastle upon Tyne,UK.
Ian Andrew
IA
James
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D015928:Cognitive Behavioral Therapy / Q000193:education*; D000068156:Formative Feedback; D006801:Humans; D013663:Teaching / Q000379:methods
Feedback intervention; supervision; training