Residency teaches you many things at once: how to think critically under pressure, how to care for patients during some of the most vulnerable moments of their lives, and how to absorb feedback while functioning on very little sleep. What no one talks about enough is how much time trainees spend trying to decode feedback rather than learn from it.
Let me set the scene: it’s the end of a long week. I’ve pushed through the daily fatigue, committed to reading something relevant for my patients every night, trying to show up sharper on rounds each morning. I stayed late reviewing lab trends, double-checked imaging before presentations, and rehearsed my assessment on the walk into the hospital. By Friday, I felt proud of how much effort I had put into improving.
Then, during feedback, the attending pauses and says, “You really need to know your patients better.”
The comment is brief and likely well-intentioned, but it lands heavily. Immediately, my mind starts racing. Did I miss an important overnight event? Was my presentation too concise? Did I focus on the wrong details? Was I supposed to emphasize the assessment more? Instead of walking away with a clear takeaway, I leave trying to decode what the comment actually meant. The task at hand now is to read between the lines, to reverse-engineer one attending’s expectations. Suddenly, the assignment isn’t clinical, it’s interpretive. What I wanted was something concrete: “When managing X, be mindful of Y.” Residency isn’t just about learning medicine, but also about learning how to navigate ambiguity — especially when it comes to feedback.
In theory, effective feedback should be specific and actionable. However, in practice, it’s often vague, hard to interpret, and shaped by individual preference. When feedback lacks clarity, our focus shifts to “managing up,” a term used to describe an adaptation to the style, tone, and personality of our superior. We tweak our notes and presentations to align with our supervisor’s preferences, rather than to grow clinically.
This raises a harder question: Am I becoming a better clinician, or just better at reading people?
Conflicting expectations between attendings only amplify this tension. What earns praise one week draws critique the next. Progress becomes difficult to measure, and perceived competence can start to reflect who best decodes hierarchy and nuance — not necessarily who has the strongest clinical reasoning.
To be clear, this isn’t about blame. Attendings are busy, often stretched thin, and many were never formally taught how to give feedback. Medicine has long relied on an informal apprenticeship model — learn as you go, adapt as needed. And variation in clinical style absolutely has value. But within that variability lies a gap: without clear guidance, learning can drift into guesswork.
Targeted, actionable feedback is what moves us forward. Instead of “Know your patients better,” consider “Be ready to discuss specific lab trends and how they inform your plan.” That kind of specificity sharpens clinical thinking and gives trainees something tangible to build on.
Adaptability is important, as medicine demands it. Managing up is a real-world skill. But it should complement learning, not replace teaching. Guessing what someone wants is not the same as being taught how to improve. I’ve mastered reading between the lines of vague feedback, though that is not what I came to residency to master.
I began asking more direct questions: What specifically could I have done differently on rounds today? Was there a moment where my communication or clinical reasoning missed the mark? Those conversations were uncomfortable at first, but they often revealed something important: many attendings had clear expectations, yet those expectations had never been verbalized.
That distinction matters, as residents cannot improve from feedback they cannot interpret. “Be more confident” or “Read the room” may sound actionable, but without examples or context, they leave trainees guessing. And when residents are forced to spend their energy decoding personalities instead of developing clinical judgment, education suffers. We focus on presentation style over substance, performance over growth. In the worst cases, vague feedback teaches residents to prioritize appeasing the attending in front of them rather than building a consistent, evidence-based approach to patient care.
Good feedback identifies a behavior, explains why it matters, and offers a path forward. “Your assessment was thorough, but you lost the team when your presentation became too detailed. Try leading with the one-sentence clinical problem first.” That is something a resident can practice the next day. Consistency matters too. Attendings should not underestimate how disorienting it can be for trainees to receive completely opposing feedback from one week to the next, with no explanation for the differing practice styles.
Medicine will always require adaptability. Different attendings will value different approaches, and learning to navigate that reality is part of training. But adaptability should be built on a foundation of meaningful teaching, not mind-reading. We do not need more feedback for its own sake. We need feedback clear enough to help residents become better physicians, not just better interpreters of ambiguity.
What is some clear and helpful feedback that you've gotten or given feedback throughout your training and career? Share below.
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