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Feedback, Like Medicine, Is a Skill You Practice

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Giving and receiving feedback is an integral part of the medical training process, but it can feel uncomfortable for both the giver and receiver. I have had colleagues tell me that they dread giving feedback, and have seen others so uncomfortable with the prospect that they avoid giving or asking for feedback altogether. But feedback doesn’t have to be awkward or uncomfortable; if it is, we probably haven’t been taught to give it well. Compounding this problem is feedback fatigue, in which the innumerable standard evaluation forms for students, teachers, and rotations seem to go nowhere and result in no visible improvements. So how can we make the process of providing and implementing feedback more effective for all involved? 

I believe the answer lies in breaking down what feedback is and why it’s so awkward for so many of us. At a recent lecture I attended by Dr. Ginette A. Okoye, professor and chair of dermatology at Howard University, I learned that feedback can be challenging because it sits at the tension of two fundamental human needs: the need to learn and grow, and the need to be accepted for who we are. With this understanding in mind, we can develop an approach to feedback that’s empathetic and affirming. Below, I offer some practical points from my own experience and from Dr. Okoye’s lecture to help clinicians deliver feedback in the best manner possible.

1) Set aside a time to deliver feedback

Receiving feedback can be emotional, so surprising someone with constructive criticism at an inappropriate or unexpected time is unlikely to be effective. Though feedback sessions can be formalized, such as a set time on the calendar for a mid-rotation and end-of-rotation review, oftentimes feedback is delivered informally and impromptu. For this latter type of feedback, giving someone a heads-up, such as, “Would tomorrow after clinic be an OK time to sit down for some feedback on how the new role is going?” allows both parties to prepare appropriately for a worthwhile session.

When the scheduled time comes up, it’s key to ensure that the recipient is in a state of mind to absorb the feedback. To do so, simply ask: “Is now still a good time to discuss how this rotation is going?” If your recipient has just had the most challenging clinic day they can remember or has recently been notified of an emergent responsibility at home, they won’t be in a place to hear what you’re telling them. An opening statement like the one above shows respect and reconfirms that the feedback given will be received and internalized by an invested reviewer and recipient. 

2) Let the recipient speak first

It is very jarring to hear feedback that does not align with our own image of ourselves. A colleague of mine recently described the experience of sitting down for a rotational review and being told that while he was doing a good job, his consult notes were lacking in detail. When recalling the story, he exclaimed: “I was shocked!” While in the feedback session, my colleague thought back to his consult weeks and recalled spending many extra hours poring over his consult notes and searching in patient charts to build detailed clinical pictures. He certainly knew that there were things that he needed to improve on, but the detail of his consult notes could not be top of the list. He didn’t remember the rest of the feedback session because he was so taken aback by the statement, which did not align with his perception of himself. 

“Shocked” is not a feeling you want the person on the other side to feel during a feedback session. Feedback that is at jarring odds with the individual’s self-evaluation risks losing both their attention and your credibility as a reviewer. A good way to mitigate this is to let the recipient speak first. Ask how they think their current rotation, new role, or recent job change is going. Doing so can help you understand their perception of themselves; if you find you disagree, you can change your strategy to maneuver the conversation more effectively. 

3) Avoid giving someone else’s feedback for them, especially if it is anonymous

Unless there are special circumstances, feedback should be given directly by the person working with the individual and encountering that individual’s work on a regular basis. Starting a feedback session with a vague generalization, such as: “I’ve heard that you have not been following up with patients in a timely manner” can create a culture of paranoia. (The recipient thinks, Who has been saying this about me? Does everyone think this?) Further, it robs the person receiving feedback of the chance to improve and follow up. 

The goal of feedback should be to induce reflection, behavior change, and improvement. When indirect feedback is given, it can be hard for the giver to answer the recipient’s follow-up questions and for the receiver to tease out the nuance of the feedback. Perhaps the issue at hand was one critical follow-up that was missed, versus a pattern of late patient calls. Or perhaps the recipient thought calling patients within a week was considered timely, but the person they’re working with required patients to be called back within 48 hours. Without the ability to ask follow-up questions and develop a plan for improvement, this sort of feedback is of little benefit to the recipient and rarely results in meaningful change.

4) Run through possible reactions and prepare appropriately

Everyone responds to feedback differently, and even those giving feedback have varying levels of stress associated with the experience. It’s possible that your recipient will get defensive, or even challenge you on the feedback you’re giving or the necessity of the behavioral change you are hoping for. If they ask you to give examples of instances in which, for example, they were late and it affected patient care, are you ready to do so? Fortune favors the prepared — if you’ve anticipated possible reactions and can respond appropriately, giving feedback will become less stressful and you will increase your efficacy as a mentor, teacher, and leader.

5) Trust that your colleagues are doing their best and want to improve

At the end of the day, remind yourself why you have taken the time to reflect on this person’s performance and to sit down with them. Ideally, you care about them and want to help them reach their full potential. Perhaps they’re an integral part of your team and helping them improve their individual performance will make a significant impact on your group’s overall performance. Or perhaps they’re a trainee close to taking on the responsibility of making their own patient care decisions. Everyone does something well; finding and recognizing someone’s special skill makes them feel seen and opens them up to hear what they could be doing better. The "sandwich technique" — starting with something positive, slipping in constructive criticism, and ending on a positive note can be a great tactic, but it isn’t the only way to keep things upbeat. If you truly come from a place of wanting to help the other person be better, that sincerity and respect will shine through. Recognize them for the things they’re doing well, trust that they want to improve, and treat the feedback process as a way to achieve everyone’s goals.

Our training teaches us to be doctors, but as physicians, we’re also supervisors and educators. When we work with others, providing feedback is an integral part of up-leveling our colleagues in their roles and ourselves as leaders. As physicians, we’re trained in thinking through problems, distilling complexity, and communicating key information. Once we realize that feedback is something that can likewise be deconstructed, taught, and mastered, we can start giving and receiving it with aplomb.

Thank you to Dr. Ginette A. Okoye, MD, professor and chair of dermatology at Howard University who taught me much of what I know and use today when I strive to give thoughtful, authentic feedback to those that work with me.

How do you think about feedback these days, versus when you were just starting out your career? Share your viewpoints in the comments below!

Rebecca Yanovsky Dufner, MD, MBA is a resident physician training in dermatology in Boston, MA. She graduated from Stanford University, Tufts University School of Medicine, and the Heller School for Social Policy and Management. In addition to her passion for dermatology, she has led cross-functional teams in health care and in tech, and is interested in health outcomes, access, and delivery on the patient and population level. Rebecca is a 2021–2022 Doximity Op-Med Fellow.

Illustration by April Brust

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