Each of these feedback approaches presents varied degrees of effectiveness and barriers to implementation, which is why we developed a simple, 4-part feedback model that we have used with notable success. We refer to our model as the CAST model:
C = Continue to do these things (maintain the positives).
A = Alter these behaviors (address things that are not yet strengths but could be).
S = Stop (discontinue the activities that do not add value or are erroneously applied).
T = Try this approach next time (offer a new skill to apply and practice).
Gaining insight into which cognitive and clinical skills are appropriately used, which ones require modification, whether behaviors should be discontinued, and which new skills need to be learned and practiced can be markedly enhanced through the use of this simple, transformative feedback approach.
On the basis of our experiences with learners and the previously described barriers to traditional feedback models, we advocate for the widespread use of the CAST model, which we have successfully used with our students and residents. The CAST model expands on the SKS process by adding a fourth dimension (ie, altering behaviors) and shifts the responsibility for feedback from the learner to the educator. We have found the model to be quick and easy to use, engaging for learners—who rarely receive the commentary as mixed messages—and not too rigid in format. We have also found it useful in providing feedback in a multitude of situations including:
Success of this technique has been evidenced through improvements in examination scores during repeated attempts, commentary provided during focus group discussions, and various survey results.
After observing students or residents, we engage them in dialogue that encourages reflection on the event, including how they felt (emotional), how it went (positive and not-so-positive outcomes), and how they intend to approach comparable situations in the future. Using this model, educators can offer learners timely and formative feedback on behaviors that were directly observed (ie, Continue, Alter, Stop), as well as feedback on specific behaviors that need to be acquired (ie, Try).
Returning to the case example presented at the beginning of the article, the third option (C) approximates the CAST model but could be improved upon. Specifically, the attending physician could have confirmed that the resident's placement of the stethoscope was correct for evaluating the posterior (inferior) lobes (Continue), while pointing out that asking the patient to inhale through only his or her mouth (not the nose) would reduce the likelihood of extraneous sounds (Alter). In addition, the physician could have advised the resident that a cursory evaluation of only the posterior (inferior) lobes is inadequate (Stop) and that future examinations must include an evaluation of the anterior (superior) lobes. Finally, the physician could have concluded with a recommendation that the resident percuss the thorax and assess for egophony when evaluating patients with respiratory complaints (Try). The other feedback options are not as desirable, as the first approach (A) provides weak feedback and the second (B) focuses on the learner, not the task.
By focusing on the behaviors observed and not the learner, and by longitudinally monitoring the learner's subsequent performance followed by additional CAST feedback, teachers can ensure that learners will receive more of what they want and need as their performance improves. (doi:10.7556/jaoa.2015.041)