The Power of Feedback

Feedback - in medicine, it’s usually a word we dance around. I feel that even if we do speak about it, it’s hushed whisper, not a strong voice. I’m a big proponent (advocate, believer) in feedback. We so often don’t provide it, or enough of it, at regular intervals.

It’s another new academic year. You can tell who are the interns and third-year medical students by their still brand new crisp white coats. I love working with our trainees. I have a third-year student from UCSD School of Medicine Friday afternoons (yes, you read right – the last block of time for the week!), and work in Residents’ Clinic Thursday afternoons.

Recently, a new third-year medical student sits across from me, smiling, waiting with an air of expectancy. I start by asking her a bit about herself – what her interests are – something in addition to the usual, “What are you thinking of going into?”

Here are some steps I take that I’ve found useful in giving meaningful, actionable feedback.

1. Provide feedback at the end of each clinical session.

I remember many a rotation as a student, resident, and fellow when the only feedback was furnished after the experience was over, in a paper or electronic form. So that led me to think, “How in the world can the learner apply the constructive comments during that rotation? It’s too late!”

2. Ask the three questions.

I learned this at a seminar recently on teaching; I don’t recall the source.

i. What went great?

My trainees seem to appreciate this one – a question others or they themselves often don’t ask enough! I relay to students my strong belief that there’s more than one item for this one.

ii. What did you take away from the patient encounter as an opportunity or opportunities for improvement?

I gently remind my students that this doesn’t have to be limited to their knowledge of say, the classes of diabetes medications, or of DKA, but can be how they communicated with the patient, how they presented the patient, or something related to their note. I also advise them that they don’t have to report more than one.

iii. What was surprising or unexpected?

This interesting question can uncover something that has impacted the learner’s experience, but as the thought may not be at the forefront of his/her mind, this may trigger a valuable insight. I’m sure you’d agree that endocrinology, indeed medicine, is rife with unanticipated twists.

3. Invite the learner to give you feedback (or, feedback is a two-way street).

I get looks of surprise, and I realize that trainees may not be comfortable providing completely candid comments while sitting in front of you. But I hope I create an environment of openness by saying upfront on day 1 that I “invite any feedback that can help make this the best learning experience possible for you.”

I invite any suggestions from you, the reader – anything that you’ve found has worked well for you in both providing and receiving feedback from your trainees, colleagues, or those you lead.