“I guess I’m just struggling to understand how I can improve my case presentation.”
I nodded toward my student and bit my lip. In all honesty, the only aspect of the case presentation I could remember was that it had not gone well. I hadn’t taken notes during it, and the details were scrubbed from my mind mere moments after the presentation ended.
I paused before opening my mouth in a vain effort to remember anything in the case presentation, before launching into a generic speech about the importance of the SOAP presentation style. The fourth year of medical school was finally upon me, and my eyes were already set on residency and patient care. Amid my acting internships and high-pressure residency interviews, my school had also bestowed upon me the role of preceptor to a group of preclinical students. The question of “am I ready to take the next step?” was yet unanswered, and the difficulty I had coaching preclinical students made the question loom larger within the recesses of my mind.
When I first entered clinicals, I felt that structured feedback was something that should come naturally to the physicians I worked with. After all, my role was the student, and their role was the teacher. My job was to be teachable, and to incorporate feedback and constructive criticism into my workflow. Their job was simply to give me that feedback. Surely, fully licensed physicians with years of experience should be able to identify my deficits and correct them in real time.
My perspective held true for many months, and over time I became more and more perplexed as to why personalized feedback often seemed hard to come across. Written evaluations were constantly sprinkled with “keep reading,” “on track with peers,” and “bright student.” When I did receive personalized feedback, it often left me scratching my head. One anonymous comment, “Student needs to learn his place,” was equally unhelpful as it was hurtful. As I trekked through third year, I became well versed at differentiating helpful feedback from generic feedback, and by the end of rotations I felt much more comfortable taking criticism in stride. Still, I often found myself questioning why it was so hard to obtain this meaningful feedback.
Within two weeks as a preceptor, though, I came to the stark realization that giving feedback was a skill. Navigating the clinical landscape was an uphill battle: One had to juggle high patient volumes, keep track of patients’ test and radiology results, form broad differential diagnoses, battle with insurance companies, and, most importantly, keep patients alive. Teaching others was an ancillary task, one to be done only after the patients were taken care of.
I didn’t even have any of those excuses, though. The environment I gave feedback in was an entirely artificial one. The clinical scenarios were carefully crafted, the “patients” were paid actors, and the diagnosis was provided to me prior to the sessions. If anything, giving students feedback in these sessions was akin to bicycling with a set of training wheels.
I hope that one day, though, I’ll be able to pedal without those training wheels. At the start of my fourth year, my school walked us through clinical education workshops that helped guide us as beginner medical educators. I learned that feedback is best provided when learners are integrated into clinical environments and feel respected within their medical team. Providing useful feedback, however, requires much more than that. It requires meeting a student where they are, which is much more difficult than I originally realized. Clinical reasoning is a complex process, and students can have deficits within a variety of domains, including their fund of knowledge, abstract reasoning, critical thinking, and problem-solving skills. Feedback on the wards must be geared toward assessing students within these domains, which means getting to know a student and how they think. Becoming good at this simply doesn’t happen overnight. I’m still a novice medical educator, but at least now I have an understanding of medical education from the other side.
I’m far from a great clinical educator, but at least I am making the effort. Now I make sure to take notes when my students interview standardized patients, and when they present cases to me I don’t hesitate to pause them if they veer off track. I’m quick to ask if my feedback makes sense, and if they think they can incorporate the changes I’m asking them to. I do think I’m ready to take the next step forward, as scary as medical residency seems. My ability to give feedback may match my fledgling clinical acumen, but I’ve got to start somewhere.
When have you struggled with giving feedback? Share in the comments.
Lachlan is a fourth-year medical student attending the USF Morsani College of Medicine. His interests include neurological research, medical humanities, and running. He was a 2022–2023 Doximity Op-Med Fellow, and continues as a 2023–2024 Doximity Op-Med Fellow.
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