A Brief Introduction to Pendleton’s Rules and Their Application in Echocardiographic Training

Feedback is the cornerstone of effective clinical training, so that correct performances are reinforced, incorrect ones are modified, and a path toward progress is identified.Feedback provides trainees with information needed to minimize the gap between desired and actual performances and encourages them to rethink and improve their performance (1).The present article describes Pendleton's rules and its benefits, criticisms, its modified form (Pendleton plus), and its application in echocardiographic training.Pendleton's rules, which outline the usual process for giving feedback to trainees (2), include the following stages:-Trainee states which items he/she has done well -Trainer states which items the trainee has done well, and discusses with the trainee how these were performed well -Trainee states which skills he feels should be performed differently -Trainer states what the trainee has to do to improve the identified skills -Trainee provides his practical performanceimproving program (3).According to these rules, the trainer provides the trainee with balanced feedback when there is a suggestion for improvement (2, 4).The trainee and the trainer first focus on the trainee's strengths, then on his weaknesses, and then the trainer provides suggestions for improvement.Thus, strengths and weaknesses are equally considered, where strengths are reinforced, and the trainee is given the opportunity to evaluate his performance prior to receiving criticism, in a way to significantly reduce defense against received criticism.Stating his own limitations provides the trainee the opportunity to rethink, creating a safe environment for receiving feedback (2, 4, 5).For learning to

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