The cycle of feedback in academic medicine can be tricky and sometimes messy. So many of us have a vivid memory of getting feedback from one of our higher ranked teachers that was rude, crude, or just socially unacceptable. There are several small steps we can take to improve our ability to give feedback – and also some suggestions for receiving feedback in case it doesn’t come packaged nicely.
For those who give feedback:
Often it is glaringly clear when a learner needs feedback – but other times it is just part of our duty. We are often too busy, too distracted, too apathetic to give our juniors the feedback they deserve. Luckily, I attended a fabulous seminar by Dr. Mary Ciccarelli and Dr. Richelle Baker from IUSoM who provided enlightening and useful advice on feedback for learners.
Way back in 1983, Dr. Jack Ende published a fabulous guideline for feedback and what happens when you don’t give it. His advice is so clearly obvious once you read it! Possibly because we over think things in our profession…
Dr. Ende’s publication indicated that if you don’t give feedback – learners make assumptions:
– Good behavior is not reinforced, so they don’t know they did a great job, AND
– Mistakes go uncorrected, so they keep making the same ones, over and over.
Therefore, we need to give feedback, to everyone, for everything – because without it the good ones might go bad and the bad ones might get worse.
The advice I’ve received and my experience suggests that it is best to avoid the basic feedback sandwich – this can feel a bit condescending (especially if you really have nothing nice to say) and you don’t always know if they understand what you are getting at…
Instead – try to use the Interactive Feedback Sandwich: (Byland C, ACGME Outcome Project, NY Presbyterian)
Ask: Self-assessment – of the specific situation you want to provide feedback on
Tell: Assess – provide your feedback to them how you felt it went well or no so well
Ask: Reflect and plan – dig deeper if needed, and then make a plan for improvement/future needs
If there is a particular area that really needs improvement – make a SMART Plan:
Specific – what to work on
Measurable – how to measure improvement
Achievable/Accountable – who and how this will be measured/documented
Relevant – how does this relate to their job overall
Time Bound – when is the deadline for improvement to be re-measured/re-mediated
Remember to engage the learner in this plan – so much so that they think that this is what they wanted to do all along – even though you used your “mentor powers” to guide them there!
For those receiving feedback:
Circling back to the feedback cycle (pun intended) – I must admit that writing about how to give feedback brings back some seriously awkward and painful memories of receiving bad feedback. Truthfully, I deserved all of the bad feedback I got. Some came from kind, respected people with good intent and nice delivery. Some I heard second hand after my supposed “mentors/teachers” complained about me behind my back. Ouch!
Recommendations for if you have to GIVE negative feedback:
Talk to each other – If my now-grown-up-(and mentor/teacher)-self has something negative to say about someone I am teaching/responsible for – it is WAAYY better for me to say this directly to them. Quite likely – they are going to hear about it eventually so… they might as well hear it from me.
HOW you say it can be as important as WHAT you say – Full disclosure, I learned this lesson from my younger sister (I was totally the “know it all” older sis – she hated it!). There is always a better, nicer way to say something. Giving negative feedback is tough – but I have promised myself that I will contemplate what I am going to say before I actually say it. And I will try to search for the kindest way to say it.
Lessons for if you have to RECEIVE negative feedback:
Try (real hard!!) not to put up the defenses– aka) just take the feedback!! If you are able to keep the calm, you will be able to ask clarifying questions that come to you. Ask questions that make it sound like you care (because deep down you should) about what they are saying.
Separate the content of the feedback from both the person giving it and/or the manner in which is its being given – This is most applicable if the person is actually being mean about it, or even worse – the feedback is hypocritical or condescending. The truth is that mean people can still give good advice.
Put yourself in the other person’s shoes – We all have a bad day sometimes. Who hasn’t lost it… just a little… at least one time?! And some people just never had a nurturing soul to steer them away from being grumpy and mean. Eh! Not your problem, it’s theirs. But you can improve yourself by taking what they say to heart and working on it.
Bottom line:Neither giving nor receiving negative feedback is easy, but it can be smoother if you have the right frame of mind.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Emily L Mueller, MD, MSc
I am a pediatric oncologist and health services researcher interested in how children with cancer interact with the healthcare system.