Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Our feedback model is broken. Here’s how to change it.

Tom Peteet, MD
Education
May 30, 2015
Share
Tweet
Share

shutterstock_153221729

I recently gave two talks at my residency program, one on health care innovation and another on intimate partner violence. I know little about each topic, but my goal as presenter was merely to know more than each person in the room. To require residents to give talks as newly-minted “experts” on topics creates a paradox of generating both anxiety and excitement in presenters. This paradox could be phrased in a dozen ways, as between fostering authority versus humility, or submission versus empowerment. I thought about these tensions after receiving structured “feedback” on my talks. In both cases, I had done a “great job engaging the audience” but failed to deliver “tangible take-home points.” In the language of the banking model of education, at the end of the talk, the students, while engaged, remained poor. The concept of feedback in medical education has become as fluid, omnipresent and ultimately empty as the concept of professionalism. Here is why.

1. Feedback is unidirectional. Despite attempts at equalizing power dynamics in medicine, the vast majority of feedback is unidirectional. The theory goes that the trainee has a list of items to learn, and needs a supervisor to assess their competence. While this model works for many concrete tasks (i.e. assessing procedural skills such as taking blood pressure, putting in a central line), it falls short of assessing most tasks in the modern health care environment. Did the trainees’ patient get better? Did the nursing staff trust the trainee? Similarly, in an educational setting, what did the students learn? How do they conceptualize the topic differently? What are they going to do with the take-home points?

2. Feedback is episodic. There is an initiative at my hospital to encourage educators to use a card outlining “one-minute feedback.” The theory is that, over time, dozens of data points will create a larger mosaic that represents a trainee’s performance. An alternative educational theory is that trainees learn by actively processing information out loud, and by creating a language to monitor their own blind spots. In other words, the concepts of critical reflection and metacognition are lost within a model of fast-food model of feedback.

3. Feedback stifles curiosity. During seven years of medical training, I have endured hundreds of feedback sessions, debating the fine-points of whether I was truly a 3 or 4 out of 5 on the scoring rubric. I nearly always leave somewhat annoyed, as if I am medication being verified, with the hidden goal is to ensure accurate documentation of my status. Only once did I leave a feedback session with renewed curiosity for medicine. The well-regarded Pediatrician asked me two questions. First, “How do you think you come across to others?” And second, “Based on your rotation, what ideas do you have for how we can deliver health care?”

Every time I meet with a medical student, I ask these same two questions. Within ten minutes, I learn more than any rubric or feedback session can tell me. I share my experiences with ideas for health care reform, commit to continuing a conversation beyond the confines of the rotation, and truly try to understand what drives them in medicine. We need traditional feedback in medicine, but we also need to acknowledge its’ limitations, both in theory and practice. At root, our feedback model is based on a banking model of education, long recognized in educational circles as deficient. In practice, the mosaic of disparate evaluations is no substitute for its opposite: a bidirectional, longitudinal, and investigative approach.

Tom Peteet is an internal medicine resident.

Image credit: Shutterstock.com

Prev

MKSAP: 53-year-old woman with swelling of the face, hands, and feet

May 30, 2015 Kevin 0
…
Next

Doctors and nurses vs. administrators on patient satisfaction. Who's right?

May 30, 2015 Kevin 33
…

Tagged as: Medical school, Residency

Post navigation

< Previous Post
MKSAP: 53-year-old woman with swelling of the face, hands, and feet
Next Post >
Doctors and nurses vs. administrators on patient satisfaction. Who's right?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Tom Peteet, MD

  • A tribute to Paul Kalanithi

    Tom Peteet, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Searching for the holy grail of clinical reasoning

    Tom Peteet, MD
  • The price of certainty in the ICU

    Tom Peteet, MD

More in Education

  • Graduating from medical school without family: a story of strength and survival

    Anonymous
  • 2 hours to decide my future: How the SOAP residency match traps future doctors

    Nicolette V. S. Sewall, MD, MPH
  • What led me from nurse practitioner to medical school

    Sarah White, APRN
  • Bridging the rural surgical care gap with rotating health care teams

    Ankit Jain
  • Why tracking cognitive load could save doctors and patients

    Hiba Fatima Hamid
  • The hidden cost of becoming a doctor: a South Asian perspective

    Momeina Aslam
  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...