In the mid 16th century, surgical education was that of a true apprenticeship. The student learned through direct observership and imitation of a skilled, elder surgeon. It wasn’t until the beginning of the 20th century that surgical education evolved into a formalized and structured program. Dr. William Osler introduced the concepts of specialty clerkships and bedside rounds in the late 1800s. Graduated autonomy, introduced by Dr. William Halsted in the early 1900s, has become foundational in the development of young surgeons. At the cornerstone of this training is the importance of feedback and critique. Both propagate personal improvement in the young surgeon in an ever-changing field.
Nevertheless, feedback frequently has a negative connotation. As trainees, we often feel that receiving feedback means we are less of a surgeon, incapable, or unworthy. But as commonplace and expected as critique is within surgical education, trainees aren’t taught how to receive and handle feedback. Within a stressful environment like residency, where personalities can be demanding and standards high, it’s important to be comfortable receiving and navigating feedback.
Receiving feedback starts with listening. The art of listening is hearing a person’s words without making assumptions. It focuses on the message to acknowledge a new perspective rather than listening to respond or defend oneself. The nuances of a comment can easily be misinterpreted when the receiver isn’t fully listening. The second part of listening is understanding the message. Asking questions is crucial. As a trainee, if you are approaching someone for feedback, be specific about what you seek.
Being receptive to feedback is to accept uncertainties. It is important to be amenable to new ideas, opinions, and strategies early in training. A vital part of growing in the early stages of a surgical career is building a repository of techniques to attack new challenges. As a senior resident, being open means recognizing the opportunities for different approaches and understanding why one may be more important than another. Just as it is important to master receiving feedback, one must consider who provides it. Does that person have the experience qualified to provide that feedback? Did they see the entire situation? Do they have a stake in your development? Do they have your best interest at heart? An important part of the reflection of feedback is filtering who should be giving criticism.
Residency is difficult, and residents try their best to keep up with its demands, but sometimes we fall short; we forget, overlook efficiency, and make mistakes. But the focus of good feedback is not about who you are, rather what you’ve done. Once we’ve listened, understood, and maintained an open mind, we can respond appropriately. A response starts before talking; it begins with body language. Body language can communicate receptivity. Be conscious of facial expressions, body movement/posture, gestures, and eye contact. Body language can convey as much as a verbal response. Use it to reinforce your acknowledgment and recognize that feedback generates an opportunity for improvement.
After moving through the stages, the door is open for clarification and further discussion about the area(s) of improvement. In my experience, there is an immense amount of value in these conversations. These dialogues can expose blind spots, provide insight, and speak to your teachability. Reflecting on feedback is the most overlooked aspect of receiving it. In what other situations can I use this advice? Should this change how I practice? Should I seek other thoughts or another opinion? After receiving feedback, consideration should be made on how it should impact your maturation as a physician.
As graduate medical education continues to innovate in the development of young physicians, the cornerstones of graduated autonomy and feedback will continue to be vital aspects of its infrastructure. Residents must understand the role critique plays in their growth and how it should be handled. Ultimately, our profession is one tasked with lifelong learning. Our commitment to this role means a commitment to our patients and striving to provide them with the standard of care. Being able to do that means responding positively to feedback, being open to learning new things, and having the courage to change and adapt.
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