Giving Feedback as a Young Physician Can Be Tough—Here’s How to Do it Right
YOUNG PHYSICIANS SECTION
Jennifer Rosenbaum, MD FAAEM
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iving and receiving feedback is critical in a medical career, but as a young physician, giving feedback can be uniquely challenging. Many physicians never receive formal training on giving feedback. I remember attending one lecture during residency on the subject. One of my biggest takeaways was “avoid the feedback sandwich.” This model describes sandwiching constructive feedback between two pieces of positive feedback. I knew this model doesn’t work, yet when I started giving feedback to students and residents, I found myself sandwiching the bad between two slices of good. Why did I feel so challenged by giving feedback? To me, it boiled down to a few issues. First, I was no longer receiving regular feedback and it is harder to model good feedback when you are not regularly witnessing the behavior. Feedback also takes time and vulnerability. It takes effort to
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It is my hope that by admitting my own limitations and knowledge gaps to learners, I’m encouraging them to do the same. I believe medical culture needs to accept that feedback is crucial to growth.
critically think about a resident’s performance and deliver that information. I was still working on my own efficiency and teaching style and I did not want those to suffer. Lastly, and probably most importantly, I suffered from imposter syndrome. As a new and young attending, I was fearful of the learner’s response from someone close to their level of training. Imposter syndrome has been well described in medical literature. It essentially boils down to a feeling of doubting your own abilities. Studies have shown that imposter syndrome affects up to 60% of medical students and 44% of residents—yet personally, I never felt like more of an imposter than when I was asked to give feedback to other physicians.1 I still find it easier to give feedback to medical students and non-physician practitioners than I do to very competent senior residents. Over the years, I’ve learned to accept my imposter persona and now focus on that vulnerability as a strength. I admit my knowledge gaps and request
feedback in return. It is my hope that by admitting my own limitations and knowledge gaps to learners, I’m encouraging them to do the same. I believe medical culture needs to accept that feedback is crucial to growth. I’m certainly not an authority on giving feedback, but I’ve put a lot of thought into the matter. And after unmasking my own imposter syndrome, true to form, I asked for help from my mentors. I surveyed some of the doctors that I thought delivered the most helpful feedback when I was a resident. Here are some common feedback pearls. Create a Supportive Atmosphere
“First, I find it tough to give constructive feedback. It takes real vulnerability on the part of both the evaluator and resident. The most important thing is that you have established a relationship with them, and you demonstrate that you care—they can tell if you don’t.” “As the teacher, you ask the learner if they are willing to receive feedback. If the learner isn’t ready to receive feedback...they are never going to hear you.” “Feedback is done in an area distinct from the main ED. I always try and find a secluded place away from everyone. I don’t want the resident to feel like they are on public display, I want them to feel like they can be open with me and have no barriers to talking about any difficult topics.” Set Up an Expectation of Feedback
“In the spirit of developing self-directed learners, I ask residents to identify for themselves the areas that they want to grow and receive feedback. Usually at the beginning of the shift I tell them, ‘In the first hour of the shift, let me know something you have been working on or want feedback on so I can keep an eye out and give you good targeted feedback along the way or after the shift.’”
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COMMON SENSE JANUARY/FEBRUARY 2024