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The Rightful Demise of the Sh*t Sandwich: Providing Effective Feedback

Published online by Cambridge University Press:  07 April 2014

Ian Andrew James*
NTW NHS Foundation Trust, and Northumbria University, Newcastle upon Tyne, UK
Reprint requests to Ian James, Newcastle General Hospital, Centre for the Health of the Elderly, Castleside Offices, Westgate Road, Newcastle upon Tyne NE4 6BE, UK. E-mail:


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

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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