Definitions
- “Feedback is personalized information based on direct observation crafted and delivered so receivers can use the information to achieve their best potential.”
What is Giving and Receiving Feedback?
- Feedback is an informal learning tool in which the work of the one learning is assessed to them by another person.
- Feedback “..should contain concrete and specific information, have irrefutable data and observations, focus on behaviors and actions rather than the learner, be limited to remediable behavior, and contain suggestions for improvement.” (Amonoo et al.)
Why should we practice the virtue of Giving and Receiving Feedback?
- Feedback is a highly effective and important learning tool in medicine, especially since medicine involves so much practical learning.
- It promotes learning, provides insights, and facilitates growth and improvement.
- Very difficult to give and to receive correctly.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
You are the senior resident on a busy vascular surgery service. A fourth year medical student, Nate, who plans to apply to surgical residency programs this cycle, is doing a sub-internship on your service, and is eager to make a good impression. He arrives an hour early each morning and often stays at the hospital until very late at night offering to help with any task, big or small.
Halfway through the rotation, you have noticed that Nate has started making some mistakes in his presentations of patients on rounds – he misses occasional lab values, or mixes up patient information. Morning rounds on this surgical service are always rushed, and you pride yourself on efficiency. Lately, Nate’s presentations have slowed down your team’s morning rounds and caused a lot of confusion.
In his eagerness to help, Nate has also started trying to take responsibility for the two third-year medical students rotating on the service. As a result, he is sometimes jumping in with wrong information during their morning presentations on rounds.
You suspect that the reason Nate’s performance is slipping is because Nate is trying to do too much, and probably not getting enough sleep. The first couple of times you caught a mistake on rounds, you ignored it, thinking it wasn’t worth making a fuss about a small mistake. Now, you find yourself increasingly annoyed with Nate, and you have snapped at him a few times about things that normally wouldn’t have gotten under your skin.
Today, Nate approaches you after morning rounds with a form to fill out providing mid-rotation feedback for him. Your feedback will factor into his overall evaluation on this rotation. Nate tells you that he is required to get this form filled out by you (the senior resident). You take the form and tell Nate to meet you this afternoon after the day’s cases are done. As you are walking away, you overhear Nate advising the younger medical students to list you as an evaluator on their clerkship forms because you are “the nice one.”
Discussion Questions
- What do you think the senior resident should say to Nate? What specific issues and goals should be discussed? In what manner should issues be presented?
- Should the senior resident have waited this long to set up a meeting with Nate? Could some of Nate’s failings have been avoided? Could he be better prepared for the impending rotation evaluation?
- Does Nate seem to have the right mindset about the feedback he is requesting? If not, what is wrong with it? How should he amend his mindset?
- Do you think that feedback should always be gentle? Should the senior resident forgo being “the nice one” and be blunt with Nate?
- Is there a balance of frankness and gentleness that can be struck? What would that look like?
- The senior resident has been getting annoyed with Nate; should this annoyance influence his feedback? Why or why not?
How do we foster Giving and Receiving Feedback?
- Giving feedback:
- Be attentive to the learner
- Build a relationship
- Make your feedback concrete, about particular behaviors you have observed, not about the learner
- Set specific goals, and be a good example
- Verify that your feedback has been accurately received, and invite clarifying questions.
- Receiving Feedback:
- Approach with an attitude of humility and a growth mindset
- Listen, and deny impulses to get defensive
- express gratitude
- Self-reflection and open communication
- The second score: In addition to your first feedback “score” of how well you are doing, give yourself a second score of how well you accept and act on that first score. Aim for a ten!