Formative vs. Summative Feedback
To best understand feedback and how to frame trainee development, it’s helpful to have a solid understanding of formative vs. summative feedback.
Formative feedback “forms” learners and enables them to make changes, refine skills and build knowledge.7 It is more frequent, goal oriented, based on observed performance and an assessment for the purpose of learning, rather than an assessment of one’s learning.7,8
You may feel tension between offering coaching-style formative feedback and being the person ultimately responsible for evaluating the learner. But you can relieve this conflict by explaining the purpose of your feedback and explicitly tying your evaluation to observed growth.
Summative feedback, on the other hand, is the sum of formative moments, based on a collection of observations and can be tied to expected competencies.9 When offering summative feedback, you should not be offering any difficult or surprise feedback. If a learner is encountering difficulties, these problems should be addressed as soon as they present themselves. The summative feedback session is a chance to check on progress in these areas.
Medicine has traditionally embraced a predominantly summative assessment paradigm, which may explain learners’ reluctance to engage with feedback.7 But in a proper culture and expectation setting, learners will engage with coaching and formative feedback more meaningfully.
Soliciting Feedback
One of the better ways to create a feedback culture is by soliciting feedback from your trainees. Trainees are often reticent to provide modifying feedback to a supervisor, preferring to adhere to a culture of politeness.10 Fortunately, there are ways around this.
Set the stage at the beginning of the rotation by making it clear you want feedback from your learners. This reinforces that feedback is bidirectional and promotes lifelong learning.
More importantly, be specific about what you’re hoping to improve. For example, “As a young attending, I’ve been told I tend to micromanage. I’m working on giving fellows more space. Could we check in soon about how I’m doing?” Being specific gives the trainee an opportunity to deliver growth-oriented feedback that might be otherwise construed as critical. Other open-ended and inviting questions: “What have other attendings done that I could do to enhance this experience for you?” and “What could I do differently to make this rotation even better?” You may be relieved or surprised by the feedback you receive and can carry it forward to your future teaching.
Pandemic Considerations
The COVID-19 pandemic has hindered our ability to develop relationships. Not only do video and telephone visits result in fewer patient interactions (i.e., fewer repetitions of the joint exam), but also in fewer opportunities for direct observation and rapport building. As we slowly return to a sense of normalcy, faculty leadership should make a concerted effort to invest in opportunities for fellows to interface with faculty, whether through dinners, journal clubs or social hours, so they can re-nurture the relationships that form the foundation for feedback.
