#MedEd: How to Give Feedback

We’re starting into a new miniseries at CREOGs Over Coffee that will be devoted to topics specific to medical education! To help us kick this off, we’ve invited Dr. Dayna Burrell, assistant professor and OB/GYN residency program director at Brown / Women and Infants, as well familiar voice Liz Kettyle, CNM, clinical instructor at Brown / Women and Infants. Now well into a new academic year, the dreaded topic on the front of everyone’s minds is delivering feedback. The word ‘feedback’ itself probably conjures up a lot of negative emotion, and Dr. Burrell and Liz are here to help change the spin on that and set you up to both receive and give feedback effectively.

For the website today, we’ll devote space to their seven tips for effective feedback:

  1. Define the time: Plan in advance. Set expectations that feedback will happen on a regular basis - after each procedure, after each delivery, on a weekly basis - whatever makes the most sense for that learning environment. When people know what to expect, and time is defined, both the person giving feedback and the person receiving it will be less anxious, and it will be more likely to have an impact.

  2. Create a positive learning environment: Setting the stage for a positive learning environment can really optimize your ability to give and the learner’s ability to receive the feedback that’s coming.  If possible, try to find a private space away from the direct clinical area. Try to pay attention to the learner’s needs -- has he been in the OR all day? Would it help to get water, coffee, a sandwich before the feedback session?  Pay attention to the small talk you’ve had with him. Do you remember any relevant details in his world? How’s that patient from yesterday doing? Is your baby sleeping through the night yet? Are you getting settled into your new place? You are demonstrating that you care about the learner as a person. You are providing feedback because you care! You are invested in his development and really want him to be successful! 

  3. Define that this is feedback happening now: When Dayna started as an APD, she was given the advice to start defining the feedback, by starting each meeting with, “This is your feedback session.” At her program, this immediately improved the perception of the quantity and quality of feedback given. It seems silly, but meetings with someone who is senior to you can be stressful and anxiety provoking and the messaging can be lost in that stress. Take the time, acknowledge the purpose of the meeting in a relaxed manner and move forward. 

  4. Allow the learner to self assess: Having the learner tell you about what she thinks went well and what could be improved upon lends tremendous insight that can make your ability to deliver feedback much more impactful.  If your views align, it can be mutually rewarding, thereby strengthening your relationship. You can validate her observations which in turn strengthens her confidence. If there is a discrepancy, a deeper dive will be required to understand how, where and why you perceive the performance differently and this may guide how you decide to approach your delivery.  

  5. The feedback sandwich, or your food analogy of choice:

    1. The traditional sandwich: positive - area for improvement - positive. A great place to start when you are giving feedback- it is very concrete. 

      • So what is the content? Start with a positive, and roll into an area for improvement- remember you aren’t trying to criticize, you are aiming to provide specific information to reinforce or change a behavior. And you can’t change someone’s personality! Focus on behaviors that you can impact. End with a positive, or a goal to accomplish. 

      • The sandwich is getting a bad wrap per the literature of being overused, and students complaining about it being predictable. So spice it up. Add condiments, maybe some dill pickles, maybe some pesto!

    • The sushi roll: the sushi rice on the outside represents the background/the positive, the tougher nori represents the area for improvement, the spicy tuna on the inside represents the end goals, the part of the bite that makes it all come together

    • The sundae: the ice cream represents that background/the positive- comes in many flavors! The toppings represent areas for improvement- also many varieties- some small and concise(sprinkles), some more wide spread (hot fudge). The whipped cream and cherry are the bonuses on top- the plans, the goals. 

  6. Engage in a dialogue: Now we need to close the loop and ask about barriers she perceives with respect to accomplishing the identified objectives. Listening openly to her perspectives on how her learning and performance can be optimized is crucial. Be prepared, the dialogue may include feedback on your institution and teaching style. 

  7. Set Goals: This is it. Arguably the most important part of the whole feedback session. Set goals to improve! How do you meet those goals, what tools do you need for success, how do you measure success. As the person giving feedback- make sure you follow up. Recognize when someone is meeting those goals, or acknowledge their effort to get there, for the sake of positive reinforcement.