Feedback: Breaking Through Barriers
I hope April finds you well and with a renewed SPRING in your step! Congratulations to all our students and programs who successfully completed the Match process. Thank you to all the faculty, staff, residents, and fellows who advised, supported, and managed the process. The Ides of March are always an exciting and stressful time, and your contributions are invaluable. I noticed a new pattern that I have not seen in a number of years – a strong pull toward family, home and partners as the primary reason for ranking and matching at a program. Personally, I think this is wonderful and a sign that students and programs are thinking proactively and intentionally about how to better integrate work and life – a critical element of wellness.
Today, I want to highlight the importance of feedback in medical and science education, because let’s face it, we all thrive when we have guidance and support. However, giving feedback in a busy clinical, lab, and work setting can be challenging. With the help of the education literature, ChatGPT, and the crowdsourcing of three peers who do this really well (Dominique Cosco, Abby Spencer, and Nichole Zehnder), I humbly offer some tips.
First, why is giving feedback hard? In addition to the challenges of finding the time, it can feel like walking through a minefield of emotions – we worry that a misstep can blow up into a bigger problem. We worry about hurting feelings or backlash, particularly if we need to provide challenging feedback. We worry that we won’t say the right thing or do it correctly. It helps to remember that the purpose of feedback is to help people grow; it is about setting everyone up for success.
So, how can we navigate the tricky terrain of feedback in a bustling clinical, lab and work setting? Here are some tips to help you provide effective feedback:
Timing is key: Just like catching the elusive last slice of pizza during noon conference, timing is everything. Choose a moment when both parties are available (emotionally and physically), ideally in a confidential setting, and can focus on the feedback without distractions. Setting an appointment at the beginning of a rotation or at regular intervals can make it easier by normalizing the process and reducing the anxiety of the person receiving feedback. Scheduling feedback time also allows you, as the feedback giver, to prepare and collect your feedback observations. It can also help reduce anxiety to ask that the other person come prepared to share feedback with you as well, reducing the hierarchy.
This is not to say that informal, unstructured feedback should not occur; it should! This kind of feedback is critical to education. It is best when it is done as something purely instructional and potentially valuable to everyone present – “holding your hands this way can help make knot tying easier”; “starting with a summary statement can help set the stage for a more focused presentation on rounds”; “limiting your specific aims to three to five makes for a more focused grant application”, etc. Sharing reinforcing feedback in this setting can also add benefit— “that was a very thoughtful question you asked Mrs. Jones”; “the way you explained her condition to her in simple terms and without jargon was very effective”; “the way you connected your research question to existing literature demonstrated your command of the material.”
Get specific, not mysterious: Being vague with feedback is as helpful as trying to find that missing pen when you have rounded on five floors. Instead, be specific. Highlight what worked well and provide actionable suggestions for improvement. A simplified structure is to frame feedback as “Keep doing this [fill in the blank]” and “Try working on this [fill in the blank] next time.” Precision can unlock the potential for growth and development. Connecting the feedback to goals and values of the recipient can also help the feedback land as relevant and timely – “I know how important patient comfort is to you, if you hold your breath when you ask a patient to hold his while listening to his heart, you’ll remember to tell him when it’s ok to take another breath.” I have also found it useful to end the feedback session with the receiver stating their action plan. Similarly, it can be helpful to schedule the next observation or feedback session so the person receiving the feedback has the chance to implement and demonstrate improvement.
Balance is important but only if authentic: We have all heard of the sandwich method – praise, critique, praise. Unfortunately, this method is probably not the most effective. People often just brace themselves for the negative feedback, not hearing the positive, or only hear the positive and fail to hear the suggestions for improvement. Providing praise is important, so long as it is authentic and grounded in specific examples. Critique is similarly best when specific, grounded in examples, and even more importantly, provides or engages the receiver in options for how to improve.
Self-reflection is a superpower: Feedback is not a one-way street. Encourage the receiver to reflect on their own performance, just like a scientist trying to answer a perplexing scientific question. By fostering self-awareness, we unlock the door to personal growth and transformation. Moreover, in my experience, the vast majority of people are more critical of themselves than you would be or than reflects reality, often making the conversation much easier. Eliciting self-reflection is easiest with specific questions – instead of “how do you think it is going?” consider “how do you think that experiment went?” or “what do you think you are doing particularly well? Is there an area of your performance you most want feedback on?”
Build a feedback culture: Feedback is most effective when it is woven into our daily fabric. One thing that I have found can work well is setting expectations around feedback on the first day including for myself. I do this by asking everyone to think about what they are working on for the next week and I pick something myself. I then ask for feedback on that thing – say efficiency of rounds. Two days later, I elicit that feedback and incorporate that feedback into our rounds. This normalizes feedback as something we do as a team. This creates a supportive culture where feedback is embraced, welcomed, and celebrated. It doesn’t always work, but I would say it has a 95% hit rate. Giving reinforcing feedback to those who are doing a great job giving feedback – to you or to someone else on the team – also helps create this positive feedback culture.
By overcoming the barriers and embracing feedback as a critical element of education and our culture as a learning organization, we can create an environment that nurtures all of our professional growth.