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If you read The Rheumatologist regularly, you may remember a column I wrote a few months ago about giving and receiving feedback (July 2017). I wrote it when I was finishing fellowship and looking back at six years of my graduate medical education. Now, as an attending physician who spends a considerable amount of time precepting fellows, I’ve started to see things a little differently.
As Spider-Man’s Uncle Ben once said, “With great power comes great responsibility.” As the newest kid on the block, I may not have that great power, but I do have a responsibility to help uphold a culture that values high-quality feedback.
In that vein, I’ve come to the following conclusions about feedback from the attending’s side:
1. Empathy is key: It’s not hard for me to remember how it felt to be a fellow. In fact, I often introduce myself as a rheumatology and allergy/immunology fellow before quickly correcting myself, and I prefer hanging out in my old haunts in the fellows’ offices rather than in my stodgy office. But to those a bit more removed from their fellow days, I recommend imagining how it is to walk in a fellow’s shoes. Understanding the fellow experience—via living it, observing it or inquiring about it—remains vital to ensuring your feedback is valuable and given on equal and fair terms. If an attending physician gives feedback on a topic that doesn’t relate to the fellow experience, it’s a waste of time. In fact, that feeds into a disconnect that may make it more difficult to relay feedback effectively to learners.
2. Keep fellows in the driver’s seat: You must show that feedback is a two-way street. I make it a habit to always inquire about my performance before giving feedback. That way, I can get a more realistic view of the fellow’s thoughts and expectations. But this is more than just asking, “Do you have any feedback?” or “How am I doing?” It’s always important to acknowledge the power differential between fellows and attending physicians. Letting them know they are free to give feedback and that such feedback is encouraged enables me to give my own feedback as freely as possible.
3. Attendings must ask for specific feedback: If a learner doesn’t give much unsolicited feedback, I ask specific questions. Common questions include, “Was the bedside teaching useful to you?” and “Did I give you enough autonomy?” I admit, I do feel a touch of insecurity when I ask in such a way, but that’s vital to keep attendings and fellows on a fair footing. Curiously, I find it even more important to do so for first-year fellows and residents because they have no memories of me working among their ranks. I imagine more senior attendings must take even more steps to ask for more feedback.