As I progress further in my medical career, I often feel that there are expectations of me that I have never been trained for. Teaching and feedback are large parts of my training that I do not always feel we are adequately prepared for. Feedback constitutes a large part of how we become better physicians. However, this commonly comes in the form of written feedback, and there is limited time and opportunity in many cases to give feedback personally to someone. However, this is uniquely valuable for four reasons:
1. I can hear your intentions. Medical students are terrified of residents. Residents fear attendings. Attendings are afraid of patients. We continue this cycle of fear, and we often feel that we have no one to turn to. We often think that the person grading us or making decisions about our careers is angry with us. When a person simply writes their thoughts down, I am not sure what their intentions are. Are they trying to hurt me? Did they hate me? Do they think I am so incompetent that I shouldn’t practice medicine at all? Are you disappointed in me? Even if the feedback is good– did you even care at all? When we can sit with someone hear from them their clear thoughts and inflections in their tone, I can understand what the person intended for me—which can help me clarify how to interpret the feedback. If they are clearly dismissive and angry, maybe this is not feedback that will be particularly beneficial to me. If they are sincerely concerned, maybe we should spend more time talking about their concerns.
2. We can clarify misunderstandings and ask questions. Feedback can be vague, and there are often opportunities for information to get lost in translation. If I do not understand the feedback, it could be secondary to there being a personal lack of understanding about the situation, either on my part or on someone else’s. We can try to clarify any issues with understanding one another and overall review the situations that either person may have misinterpreted. Feedback given without an opportunity to ask questions is not good feedback at all. I want to be able to ask about what was meant by something. This will not only help learners but should be a minimum expectation.
3. We can talk openly about growth strategies. When feedback is given in person, we can transition the conversation from focusing on previous performance to focusing on moving forward and discussing methods to grow. These are some of the most valuable parts of in-person feedback since I can spend the time with a person actively reflecting and thinking about what tangible steps I can take for growth. These change from being done alone to being done with another human being who is able to guide us and on the road to growth as a physician.
4. There won’t be any surprises. My written evaluations used to make me angry. Like visibly angry. My family used to rue the day that grades came out and comments were posted. I would stew over them for hours, trying to read between the lines and thinking of everything these vague comments could have meant. After all, these were the culmination of so much of my work, often for as long as 12 weeks. After a few rotations, I simply just stopped reading them since they had little to add to my mental health. What bothered me most about these evaluations wasn’t that they were there, but because I was always profoundly surprised about what was going to happen. And if there is one thing I hate, it is surprises. Like many people in medicine, I want to control every aspect of my day-to-day life. However, if the primary feedback mechanism were in person and the in-person feedback matched the written feedback, there would be no surprises. There are no afternoons where I loudly suck down cup after cup of tea, stewing and being angry. Instead, these are quickly turned into growth opportunities, and I will walk away knowing how to become better earlier.
I hate feedback. It makes us all a little uncomfortable, even though we know we need it. It’s a little less scary when it happens in person and less as it is an evaluation. We can all make the medical world a little more humane by giving it in person.
Micaela Stevenson is a medical student.
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