Giving effective feedback: Learning from Medical Education

Feedback is all about enabling people to improve their performance; particularly where they have blind spots about their performance or behaviours.

In terms of learning how to give effective feedback, it is useful to look beyond our own organisations and learn from best practice in other environments.

In medical education, Pendleton’s rules (Pendleton 1984) are generally used as the conventional method of providing feedback. Pendleton’s rules are structured to create a safe environment so people are less likely to become defensive and, therefore, more likely to be open to feedback.

Strengths and positives are highlighted first. The positives are then reinforced and, if appropriate, more strengths are added by the person providing feedback. This reinforces the positives and also allows discussion of the skills necessary to achieve these positive outcomes.

The next stage is to explore what could be done differently. This is done first by the person receiving feedback and then by the person providing feedback.

Avoiding a discussion of weaknesses at the beginning of the conversation prevents defensiveness and allows people to reflect on their performance and to create their own solutions.

This model, adapted below, provides a useful structure for assisting with difficult conversations, performance conversations or appraisal review meetings.


  • Ask the person what they think went well/what were the positives/their strengths
  • Reinforce/add more positives where appropriate
  • What were the skills/approaches used to achieve the successful outcomes? Discuss.
  • Ask the person what could have been done better. Analyse the alternative skills which would be required to improve this.
  • Suggest alternative skills/approaches if necessary
  • Ask the person to summarise their strengths and areas for development.
  • What are the next steps/plan of action?
  • Any evaluation or review? 

Julie McDonald
Director of People Solutions

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