Sour Notes: Giving Effective Feedback

A long time ago in a small city named Kalamazoo, I received a Bachelor of the Arts in Music. During my time in music school, constant feedback and criticism from my colleagues and professors was a big part of the experience. Different teachers had their styles – the trumpet professor would make his students leave in tears after a “bad” encounter. My trombone professor would sigh, cross his legs and start to trim his fingernails when he didn’t approve of what he heard. The immediate feedback I received by from professors however quirky lead to my improvement in playing my instrument.

During this time, I taught music students and was paid to give my pupils meaningful criticism and feedback to nurture their talent. Learning to give and ask for feedback in the moment is not only helpful to the learner but will improve your teaching abilities.

Unlike my experience in music school, I have found that during my medical education, feedback and criticism was shrouded in secrecy only to be revealed when I received my MSPE letter or an anonymous email from an evaluation bot. Some emails were rich and descriptive whereas others lacked details, and concrete examples of how I could improve. I have received immediate verbal feedback but more often than not it was delivered inappropriately without regard to professionalism (insert expletive), directed at my behavioral traits (“quiet, needs to say more” or “talks too much”) or the old pat on the back “he did a good job”.

I played a lot of sour notes in college – there is no way to hide from not having practiced your scales! Negative feedback can be a powerful and motivating tool if delivered effectively.

Effective feedback incorporates:

Concrete evidence to support the feedback
Eliciting from the learner how they viewed the situation.

In my experience (and personal preference as the receiver of negative feedback) this is best done immediately upon observing the behavior.

Recently, more emphasis has been placed on residents as teachers by ACGME because – let’s be honest – doctors are expected to be excellent teachers by their patients and colleagues but teaching is not an innate ability. And why should it be? A graduate with an education degree has had hours of teaching methodology, psychology, development and observed apprenticeship before being unleashed into a classroom. The responsibility of teaching will be thrust upon thousands of graduating medical students in July. These new doctors are used to figuring things out for themselves to make the grade and few have any experience in teaching.

Here are a few practical tips to improve the way in which you give feedback!

Chose your environment carefully – during rounds with a large audience is not the time to give negative feedback.

Ask the learner how they viewed their performance. This should always be done prior to giving your feedback.

Do not focus on behavioral attributes. Let’s get real here, none of us doctors are “normal” (another time, another blog post).

Not only provide feedback but give specific examples and suggestions on how to improve. Sending an evaluation bot that states “hey you suck” is not helpful. Besides, perceived deficiencies to that level should be pointed out and discussed in real time so that real changes can occur.

Find your style. Some like employing the s@$# sandwich (good, bad, good feedback), others like the straight shooting approach. Whatever you observed has worked well as the recipient of feedback in the past, try to emulate that.