Fellows’ Forum: 6 Tips to Improve Professional Feedback

Feedback needs to be nuanced and invite the learner to take action rather than dwell on what has already been done and can’t be changed.

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I was driving to work one morning when I stopped behind a truck at a red light. The driver had placed several flashy stickers on the bumper and back doors. But what I was drawn to was a more commonplace sign: “How’s my driving? Call this number to give feedback.”

It’s routine to find a sign like that on commercial trucks, but what made it memorable was that the last two digits of the phone number were completely covered by a thick layer of dirt and mud. I could not give him any feedback, even if I tried. As I drove onward, I thought, “Maybe that was by design.”

In many ways, that’s how feedback is during residency and fellowship. Everyone says that feedback is welcome, but when it comes to actually giving it—or taking it—there’s a major disconnect between words and action. And that’s too bad, because, arguably, feedback is at the heart of education.

Feedback is a form of formative evaluation, a way of sculpting ourselves in small but meaningful ways so that we can get to our personal best. Without feedback, we can only fall behind others as they improve.

With that in mind, here are six tips to keep in mind when giving (and receiving) effective feedback:

1. Feedback Is Neither Positive nor Negative

We tend to think of feedback in biologic terms, with it being either positive or negative. But that scale doesn’t fit when it comes to feedback. Feedback is high quality or low quality.

Most trainees are intimately familiar with the crap sandwich, the type of evaluation that starts with something good but then turns nasty and negative, and finishes off on a vaguely sweet note. When structured in that way, feedback becomes stigmatized and inauthentic. The words of the evaluator become less and less meaningful, and the entire encounter becomes stressful in anticipation of getting to the bad parts. That’s low-quality feedback, and sadly, that is ubiquitous.

2. Feedback Must Be Objective

Instead of the crap sandwich, I recommend a more nuanced approach. Instead of appraising first (“I like what you are doing but …”), start with observations (“I’ve noticed that you do this”). That takes a lot of the broad-based judgment out of feedback sessions. It also invites the learner to think about and comment on their habits, leading to action rather than dwelling on what has already been done and can’t be changed.