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Wednesday, March 23, 2011
The Page 2 Blog-Education: How to deliver feedback
“Great day; thanks for your help!” is not adequate feedback, though it constitutes the end of the day summary for most trainees. Any educator can tell you that it is neither possible to teach nor to learn without reflection, and that means giving or receiving feedback. This feedback closes the educational loop. The operating room, clinic and ICU are full of opportunities for close observation. Yet, despite these close encounters, a common complaint from trainees (residents, fellows or nurses) is that they receive no or inadequate commentary with regard to their performance. What are the barriers? Many people blame our work environment; it’s too busy and too public. Many faculty members avoid giving negative feedback because they don’t want to be perceived as judgmental. They fear retribution should their opinion become a factor in the demise of a trainee’s career. This can lead to the common practice of venting out in the corridor to anyone except the trainee. This is obviously not an educational experience for either party.

Positive feedback is much easier to deliver, but it still requires skill to make comments effective and specific. Here are some suggestions for delivering critique that I have found successful:

1. Give the student a heads-up that at some point in the day there will be a discussion of performance. This allows them time to prepare and be reflective.
2. Deflect their tendency to dwell on technique to the exclusion of everything else. Yes, it is important to get the intubations and lines, but this is not the “be-all and end-all” of a good day.
3. Stop “tag-teaming” the workday. You must really observe the action, especially the trainee’s interactions with patients and others. Make some notes of both good and bad things you have witnessed.
4. Give feedback throughout the day because chances are you will be too tired or distracted to conduct a formal sit-down session at the end of the day, although this would be ideal. Good feedback can be given with others around; privacy is in order for anything else.
5. Avoid the “feedback sandwich” where you deliver the bad news buried between the good news.
6. Expect to be surprised because there are often good explanations for things you might criticize.
7. Ask for feedback yourself! Pedagogy works both ways.

Without proper and timely feedback the learner is either left to search for clues or simply make the assumption that all is fine. From the literature on performance assessment it is clear that people in general do not have good insight and the poorest performers often have the least insight relative to high or adequate performers.(Hodges B, Regehr G, Martin D: Difficulties in recognizing one's own incompetence: novice physicians who are unskilled and unaware of it. Acad Med 2001; 76: S87-9)

Could this be because they heard that they had a “great day” when they should have been pulled aside for timely and appropriate comments based on their performance?

Additional Resources:
Ende J: Feedback in clinical medical education. JAMA 1983; 250: 777-81
Bing-You RG, Trowbridge RL: Why medical educators may be failing at feedback. JAMA 2009; 302: 1330-1

What has helped you with delivering or receiving feedback?

Posted by L. Jane Easdown, M.D.
L Jane Easdown, M.D.
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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