title: Targeted Feedback in the Milestones Era: Utilization of the Ask-Tell-Ask Feedback Model to Promote Reflection and Self-Assessment.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education's Milestones Project focuses trainee education on the formation of valued behaviors and skills believed to be necessary for trainees to become independent practitioners. The development and refinement of behaviors and skills outlined within the milestones will require learners to monitor, reflect, and assess their own performance over time. External feedback provides an opportunity for learners to recalibrate their self-assessments, thereby enabling them to develop better self-monitoring and self-assessment skills. Yet, feedback to trainees is frequently generic, such as "great job," "nice work," or "you need to read more."
  
  
  OBJECTIVE
  In this article, we describe a feedback model that faculty can use to provide specific feedback, while increasing accountability for learners. We offer practical examples of its use in a variety of settings in the milestone era.
  
  
  METHODS
  The Ask-Tell-Ask (ATA) patient communication skills strategy, which was adapted for use as a trainee feedback model 10 years ago at our institution, is a learner-centered approach for reinforcing and modifying behaviors. The model is efficient, promotes learner accountability, and helps trainees develop reflection and self-assessment skills. A feedback agreement further enhances ATA by establishing a shared understanding of goals for the educational encounter.
  
  
  CONCLUSIONS
  The ATA feedback model, combined with a feedback agreement, encourages learners to self-identify strengths and areas for improvement, before receiving feedback. Personal monitoring, reflection, self-assessment, and increased accountability make ATA an ideal learner-centered feedback model for the milestones era, which focuses on performance improvement over time. We believe the introduction of the ATA feedback model in surgical training programs is a step in the right direction towards meaningful programmatic culture change.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: frenchj2@ccf.org.
authors.forename: Judith C
authors.initials: JC
authors.lastname: French
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio.
authors.forename: Colleen Y
authors.initials: CY
authors.lastname: Colbert
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio; Department of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lily C
authors.initials: LC
authors.lastname: Pien
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio.
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Dannefer
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Taylor
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods*; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D017145:Models, Educational; D012647:Self-Assessment; D064871:Teach-Back Communication
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Professionalism; ask-tell-ask; feedback; learner accountability; reflection; reflective practice; self-assessment