CET On Teaching
Approaching Feedback
Pamela Petersen-Crair, M.D.
Imagine this...you're an upper level resident in charge of medical students on your rotation; it's half way through the students' rotation and they look to you for feedback. You know that the attending psychiatrist does not give meaningful midway feedback, so either you do it or the students get nothing and thus receive minimal guidance for improvement. You jump in feet first with little knowledge or training about giving feedback and hope you don't crash and burn.
What's the difference between feedback and evaluation? Feedback is often given midpoint during a rotation and again at the end of a rotation. It is based on observations and does not involve comparing individuals to their peers. It is based on events--what was done or not done by the student. It provides the student with ideas of what should be done differently. It conveys a sense of concern for the student's development as a physician.
Evaluations, on the other hand, are often done after the rotation, compare an individual to his or her peers and are more subjective about how the individual met the goals of the rotation.
Numerous barriers exist to giving feedback to students. First, there is often a lack of objective data upon which to base feedback. Ideally, both faculty and residents would observe students interacting with patients on multiple occasions during a rotation, but sometimes this does not occur and thus there is less objective data available regarding the student's performance. Second, giving feedback requires a lot time, especially for faculty who ideally should be giving feedback to both medical students and residents, preferably at least twice during a rotation. This can add up to a lot of "feedback hours." Finally, there's a fear that the feedback will have unintended consequences, such as hurting the student, damaging the student-teacher relationship, lessening the popularity of the evaluator, or the student perceiving the feedback as an indication of personal value rather than of performance.
Poor feedback can take many forms. Poor feedback includes giving no feedback, giving harsh criticism, or giving glowing praise that does not help the student identify areas for improvement. When poor feedback is given, there are numerous adverse consequences. Students are not given an opportunity to correct their mistakes. They are not given any guidance on how they are developing as physicians and how they are meeting the goals of the rotation. They may begin to project their own thoughts onto the situation whereby the insecure students determine they are failures and the confident students become arrogant. Finally, without good feedback, written exams become overly important. If you have never been trained in giving feedback, all is not lost. Below are some guidelines to get you started:
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The teacher and trainer should be seen as allies.
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First-hand data should be used from your own observations of the student, such as, "You were able to develop a good rapport and obtain a thorough past psychiatric history. You could have asked more questions about substance abuse history," versus "That was lame."
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Feedback should be given privately at a mutually convenient time and students should be informed at the beginning of the rotation that feedback will be given midway and at the end.
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Focus on behavior that can be changed.
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Pay attention to your own countertransference.
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Avoid feedback regarding the student's personality traits unless these traits are interfering with the student's ability to become a good physician.
With practice, feedback can become a mutually gratifying experience for both the student and the resident, and students will come to appreciate the time you have taken to help them become better physicians.
The author would like to acknowledge Psychiaty Grand Rounds at Baylor College of Medicine.