Prepare to ADAPT

Here at UW we care about providing excellent teaching and clinical care. A key component of always improving is giving and receiving quality, and effective feedback. We use a model developed here at UW Medicine for delivering and asking for feedback called “Prepare to ADAPT.”

​What is “Prepare to ADAPT”?

The Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) feedback framework is an approach to asking for, receiving, and providing feedback in the clinical learning environment.

Why “Prepare to ADAPT”?

The “Prepare to ADAPT” feedback framework is a theory-informed conversational approach to feedback based on the “Ask-Tell-Ask” discourse pattern that providers often follow with patients. The “Prepare to ADAPT” feedback framework adds 1) a “Prepare” step, emphasizing learner reflection on goals, and 2) a “Plan Together” step for the creation of an intentional follow-up plan for improvement.

​Based on our pilot study at the University of Washington, we found the model to be efficient and flexible, particularly for formative feedback. We also found that clarity around the process of feedback for both learners and coaches was perceived to reduce “feedback stress” in the clinical learning environment. The model can be utilized in various clinical scenarios and can take as little as five minutes, or can expand based on the situation and needs. Learners who normally struggle with how to ask for feedback—and coaches who struggle to provide meaningful feedback—find it particularly useful.​

Practice using the “Prepare to ADAPT” framework in your clinical practice

Learner Initiates

• Reflect on learning goals.
• Communicate your goals.

Prepare

for the observation

⇓

Coach Initiates

• Reflect on program & learner goals.
• Orient learner to expectations.
• Try to be natural Perform • Try to be neutral

• Reflect on the observation

• ASK for feedback

Ask

⇔

• Reflect on learner’s readiness

• ASK for his/her thoughts about the observation
• Have a conversation about the observation

Discuss

⇔

 • Coach observed, modifiable, specific behaviors related to the task(s)
• ASK for clarification

Ask

⇔

 • ASK learner to clarify points, as necessary
• Plan next steps with your coach

Plan Together

⇔

 • Plan next steps with your learner

Developed at the University of Washington, UW Medicine, by Susan Johnston, EdD; Judith Pauwels, MD; Kristen Patton, MD; Tyra Fainstad, MD; Addie Hearst McClintock, MD

UW GME recommends the use of this framework with residents, fellows, and faculty so that that a common approach and language about feedback is shared throughout the learning environment.​

​Download ADAPT Model Summary (PDF)

Learn about “Prepare to ADAPT”

Two companion learning modules utilizing “Prepare to ADAPT” feedback framework have been developed: One for learners and one for coaches.​

“Prepare to ADAPT” for Learners: Getting the Feedback You Need

This module empowers learners to ask for feedback with “Prepare to ADAPT.” Learners are encouraged to take initiative in doing the following:​

    1. Identify their coaches—attendings, peers, or other individuals in their learning environments
    2. Share the feedback framework with their coaches
    3. Capture the most salient feedback points for next steps.
View “Prepare to ADAPT” for Learners

Prepare to ADAPT for Coaches: Providing High Quality Feedback

This module identifies learner attributes that create feedback successes as well as challenges. Coaches apply principles to help create a learning environment that encourages the feedback process, while employing the “Prepare to ADAPT” feedback framework to give useful, brief, specific and actionable feedback. This eLearning module takes about ten minutes to complete.

After coaches “Plan Together” with learners, learners can be encouraged to document “Next Steps” or “Take-Aways” from the discussion. Documenting the most salient features of the discussion supports longitudinal learning. Suggestions for learners and coaches include:

View “Prepare to ADAPT” for Coaches

How to Use “Prepare to ADAPT”?

Here are a few tips for implementing the Prepare to ADAPT model in practice.

  • Sharing the framework with coaches/feedback receivers ahead of time so they know what to expect.
  • Figure out a system to track feedback and longitudinal learning best suited for you/the individual learner. Some options include: keeping a “feedback log” of “Plan together / Next Steps,” either as notes on a phone, on a computer, in an actual notebook, or on notecards in your pocket, or using a mobile phone to dictate (or type into a computer) “Next Steps” into a program assessment database system (e.g., MedHub, eValue).​ Save these suggestions to review at a later time.
  • Incorporating the “Next Steps” into an Individual Learning Plan (ILP).

What residents and fellows have to say about “Prepare to ADAPT”

  • “Quick and simple, and gave very specific things to do.”
  • “Feedback doesn’t have to be a huge cumbersome process. You can do it on the go.”
  • “…it’s the best learning module I’ve ever done!!! …I’m so glad I got to do this one!”
  • “We don’t get enough feedback… this is a great approach.”
  • “I can’t remember getting this kind of feedback before…. This is new. It is like a two-way street with the planning together piece.”
  • “The module is easy to use and didn’t take very long.”

More Resources on “Prepare to ADAPT”

The following is a list of additional resources: