Giving feedback and asking for it is vital to progressing medicine

Giving and receiving feedback is really hard.  When I left training and joined the faculty at a major medical school last year I found many things about my new position daunting.  Fitting into a well established practice; learning a new system; being a teacher; juggling different services and roles; billing appropriately; and last but not least, giving feedback.

Psychological and logistical hurdles make it challenging to deliver feedback.  Constructively criticizing the residents and medical students, not to mention peers, is not as easy as it seems.  For one, junior attendings are often in the uncomfortable position of being in the same age group as our trainees.  This sets up a challenging dichotomy.  On the one hand, there is a desire to befriend the trainees and on the other hand there is an obligation to serve as a mentor and role model.  Critiquing performances is hard because it could potentially place an impenetrable rift in developing a friendship.  Also, it’s just plain awkward to give feedback to somebody who is in the same age group or even older.

Some attendings face the conundrum of wanting to encourage rising stars instead of discouraging them.  For people who perceive feedback as negative, this can pose a barrier to sharing it at all.  On the other hand, some people might simply want to use feedback as an excuse to exert their power over trainees.  This is usually the result of unconscious feelings of inadequacy that are unfortunately projected onto the unsuspecting trainee.

Logistically speaking, everyone has increasing responsibilities.  It’s challenging to find time to supervise and evaluate.  Often I’ll find myself wanting to point out something really good or really bad that a trainee did, but due to the circumstances like the presence of other staff or proximity of patients, I will make a mental note to do it later.  The trouble is that one mental note quickly becomes a thousand and feedback sessions easily get triaged.

Now that I am on faculty, I have discovered that I no longer receive feedback.  This really struck me a few months into my new position.  Recently it occurred to me that attendings mostly get direct feedback during quality reviews or morbidity and mortality meetings.  These are necessary and useful meetings, but it puts us in a scenario where we only hear about the negatives and not the positives of our work.

Of course, I could always ask a colleague for input about my performance.  But being a new and young faculty member, I am very aware that some people could perceive me as a trainee.  I am ambitious and would like to be promoted, so I need my colleagues to consider me as a competent equal, and not as someone who still needs supervision.

The more I thought about things, however, I wondered if asking how I’m doing would jeopardize my reputation or anyone else’s for that matter.  Shouldn’t we all be held accountable for our education and performance?  Shouldn’t we always strive to improve our work, regardless of our age or stature?  Attendings, fellows, residents, and students should take a more proactive role in soliciting feedback.

I propose that all medicine personnel should be just as responsible for asking for feedback as they are for giving feedback.  Information about performance and underperformance is invaluable at improving our quality of work and ultimately maximizing patient care.

I believe that the only way to improve our skills is to give each other constructive assessments.  Because this has proven to be so challenging in practice, I suggest four ideas about how we can help each other give and receive feedback.

Firstly, the environment must be safe.  Barging into someone’s work space and yelling at them in front of peers, for example, would disqualify as safe.  Meeting in a private office, or better yet over a cup of coffee, would create a situation where defenses are low and camaraderie is high.

Secondly, delivery of feedback must be consistent.  A student or peer is much more likely to keep negative critiques in context if they are regularly given a review of their performance.  Everyone is pretty much expected to do a good job when they come to work, so that good job often goes unacknowledged and feedback is mostly given when something unexpected or unfavorable happens.  While it might seem trivial to praise every minor task accomplished, acknowledging good behaviors every now and again is just as important as pointing out the errors and helps to keep things in context.

Next, feedback should always incorporate positives and negatives of performance.  In the cases when feedback is critical, the person hearing the message will be less defensive if they first hear something good about themselves.  Surely there is something to complement whether it is performance, skill, timeliness, professional dress, or eagerness.  Once someone is assured that they have some value, they will be more receptive and accepting of criticism.

Finally, we all must ask for feedback in addition to giving it.  Trainees should not just wait for it, and attendings likewise should seek it.  It enhances everyone’s credibility when we pursue knowledge about our strengths and weaknesses.  I now ask my senior colleagues for feedback, and I ask my trainees for it too.  This gives me tremendous information and has the added benefit of making others feel valued for their opinion.

Giving feedback and asking for it regularly is vital to progressing medicine and our individual performance.  So, I suggest that we all candidly start asking each other, “How am I doing?”

Helen M. Farrell is a psychiatrist who blogs at Frontpage Forensics and can be reacted on Twitter @HelenMFarrellMD.

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