How the ARISE model transforms feedback into professional growth [PODCAST]

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Alicia DiGiammarino, an expert in health professions education innovation and research, discusses her KevinMD article, “Transform feedback into growth with the ARISE model.” Alicia explores how the ARISE model—Ask, Receive, Interpret, Set next steps, and Express gratitude—provides a structured approach to receiving and applying feedback effectively. She highlights the psychological barriers like the amygdala hijack that make feedback challenging and offers actionable strategies to navigate these reactions. The conversation emphasizes fostering open communication, building resilience, and leveraging feedback to enhance teaching, mentorship, and patient care.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today, we welcome back Alicia DiGiammarino. She specializes in health professions education innovation and research. Today’s KevinMD article is “Transform feedback into growth with the ARISE model.” Alicia, welcome back to the show.

Alicia DiGiammarino: Thank you.

Kevin Pho: All right, so let’s jump straight into your most recent KevinMD article. But before talking about that, what led you to write it in the first place?

Alicia DiGiammarino: Last fall, we at the Teaching and Mentoring Academy at Stanford School of Medicine conducted a giving feedback workshop in which the formal content got completely derailed by personal stories about how challenging receiving input can be. So we’re really hearing more and more from faculty and students who are struggling with or completely avoiding feedback conversations. And that’s troubling, given that medical education is built on an apprenticeship model in which more experienced clinicians help trainees build competency over time in a patient care setting.

So we’ve been working on developing a tool that can help people structure their response to feedback and allow them to reflect on and build that skill. And we developed a workshop on receiving feedback that we’re now delivering and getting very positive feedback on. So having a tool like this model that is in the article can provide that structure in the moment and help people reflect on and improve their skills in receiving feedback.

Kevin Pho: All right, and before talking about that model, let’s go deeper in terms of the role of feedback when it comes to medical training. And you likened it to an apprenticeship model where feedback, of course, is critical to that. So from the medical students, residents, and interns that you encounter, tell us the role of feedback in their growth.

Alicia DiGiammarino: I would say that folks should, and sometimes are and sometimes aren’t, receiving feedback all day, every day, right? As they’re learning how to do procedures, how to communicate with patients. I actually recently read a 2024 study in BMC Medical Education. It’s called “The feedback dilemma in medical education,” and the authors found that 78 percent of residents agree that feedback improves clinical performance, but only 25 percent report receiving regular feedback.

So some trainees might not be recognizing when they’re getting feedback. But even so, that’s a strikingly low number of people who feel that they’re receiving feedback on a regular basis. But of course, if you think back on your own training, it’s so important to developing skills and knowledge.

Kevin Pho: All right, so tell us about your article and the model that you want to introduce.

Alicia DiGiammarino: Yes, so the model is called the ARISE to receive feedback model, and it’s an acronym that stands for Ask, Receive, Interpret, Set next steps, and Express gratitude. So I can walk you through those steps.

The A is for ask, and that’s really where you get to take the initiative. You ask yourself what kind of help you need and who do you need it from, and then you ask for feedback. And as I’ve talked about already, we grow as clinicians and educators by stretching outside our comfort zone and asking for feedback from multiple sources.

The R is for receive, and I like to say that feedback is a gift because actually giving feedback is very, very hard. So actively listening as you receive it shows respect to the giver while allowing you to take it all in. And at this point, you might want to note your immediate response. Do you feel angry or sad? Are you getting defensive? And once you identify how you feel, you can choose your next steps rather than proceed on autopilot. So I like to say, in the receive step, you can actively select a mindset of curiosity.

The I is interpret, and this step is so important and very easily skipped. So the idea is, rather than responding right away, give yourself time to absorb that feedback and reflect on what it means and how it sits with you. You might ask yourself, “What feels right about it? What do you disagree with?”

The S is set next steps. So now you’ve heard the feedback, and you’ve thought about it, and now you get to decide how to use it. So you might even write down what you’re going to do with the feedback. And at this point, it’s also good to think about how you did receiving the feedback. What went well? What could have gone better?

And then the E is express gratitude because, as I said, it is almost as hard to give feedback as it is to get feedback. So ideally, you take that moment to thank the person for their thoughts.

Kevin Pho: So using this structured model, how does that contrast with a traditional way of giving feedback, perhaps without the guidance of a model like this?

Alicia DiGiammarino: What happens a lot is that people think about feedback, and they think about the giving aspect. And what we’ve realized is that there is a whole another side to the puzzle of receiving feedback and that the receiver also has responsibility for turning feedback into a productive conversation. So I think what this model does is it gives the receiver that structure to take a step-by-step process to receiving feedback and build that skill by reflecting on how they did using the model.

And then the ideal would be that eventually you kind of let go of the model, and you’re able to do it on your own. But like anything in medicine, and we have so many acronyms, right? You got to take that time to learn that skill and develop it and then become competent in it.

Kevin Pho: All right, so tell us the outcomes after implementing a model like this.

Alicia DiGiammarino: Well, for the individual, the ideal would be that learners and educators are developing better rapport, that they’re taking in more knowledge and feeling like they can advance in their skills more quickly. For us at the teaching and mentoring academy, we have been getting extremely positive feedback on our new workshops based on this. And people are saying that it’s just really provided that opportunity to think about something that they hadn’t thought about before.

So yeah, we’re excited. We’re excited to advance these. And actually, we’re working it now into a series about feedback that will kind of cover giving feedback, receiving feedback, and then challenging conversations. And then we’ll have actually a day dedicated to practice.

Kevin Pho: So it sounds like giving and receiving feedback needs to be formally taught. And is that being done in Stanford among the medical students and future clinicians that are being trained there?

Alicia DiGiammarino: That’s a good question. We have a lot of coverage around feedback at different levels at Stanford. I would say we’re talking a lot right now in medical education in general about the learning climate. And there are a lot of definitions of the term, but I essentially think of learning climate as, “How does it feel to be the learner and the teacher?” Like, do you feel safe and respected? Is it a physical and emotional space that’s conducive to learning?

And what I’m wondering, related to what you said about formalizing this type of training, is, would the learning climate improve if, across the country, we incorporated formal training on giving and receiving feedback into training from preclinical trainees all the way to faculty development? And it’s actually not the easy question to determine how much this would improve the learning climate, but I do think it’s worth exploring.

Kevin Pho: Now, for those teachers and clinicians having to give feedback to their students and mentees, what are some tips that you could share for them to give constructive feedback within the confines of the model that you’re describing today?

Alicia DiGiammarino: Yeah, absolutely. For one thing, I would say if you’re looking for more in-depth exploration of this topic, you might consider checking out the book Thanks for the Feedback by Douglas Stone and Sheila Heen. And I can share a few of the tips that they provide in that book that I really love.

First is dismantle distortions. So basically, the idea is to think about the story that you’re telling yourself about the feedback versus what the actual feedback is. So for example, a negative evaluation from a learner might be about whether that particular student likes you as a teacher, but not whether you’re likable or other students like you.

Another really great tip is to think of yourself as a complex being. And the idea is avoiding an all-or-nothing mindset. So you will make mistakes. Accepting the fact that everyone makes mistakes can take some of the pressure off receiving feedback. Most people have very complex intentions, and people mostly have good intentions. They might sometimes act in self-interest, and everyone does that. And just this idea that you will sometimes contribute to issues, and there will be feedback along your journey.

And then my own main tip is that to improve, you really need to reflect during and after getting feedback. And I mean, you could start right now by thinking back on a recent moment that you received feedback, for instance, this week. How did it go? How did it feel? What did you do well? What would you do differently next time?

Kevin Pho: Can you tell us a story or a case study of the ARISE feedback model in action and how it contributed to significant growth? And could be a hypothetical story, but just to kind of see some practical implementation of the concepts.

Alicia DiGiammarino: Yeah, sure. So we did a survey with some of our folks that registered for the workshops, and we asked them to share times when receiving feedback was really, really hard. And it actually validated my own prior reactions to feedback because everyone has an experience around this.

So one person shared a time when they had just completed a major project that they invested a lot of time and effort into, and they were very excited to present the work to their team and were expecting that the team would see all the effort that they had put in. But instead, the team lead ended up providing a lot of points of critical feedback and highlighting a bunch of shortcomings for the project. And that person described feeling blindsided and defensive. And they said, “The feedback felt very overwhelming, and I really struggled with disappointment and frustration.”

So this is an example where you could see implementing the ARISE model. So if you are at the R step, let’s say, so you’re receiving this feedback from your team lead, you might kind of think about what you’re feeling as the person is sharing that feedback. And if you can actually identify what you’re feeling, you can choose to not proceed on autopilot and change your reaction.

The step I here would be thinking about, “What does this feedback mean? Does it really mean that I did a horrible job on this project, or does it mean that my team lead had some suggestions?” So what feels right about the feedback? And there might be things that you still disagree with, and I think that’s OK.

The S would be set next steps. So this person might think about, “OK, what am I going to do with the info that my team lead gave me? Am I going to go and change my project? Am I going to decide to talk to my team lead about why I disagree?” So this is where you own this step, right? You get to spend, my faculty I work with like to say, you get to spend the gold coins of feedback at this point when you set the next steps.

And then this E of express gratitude. So is it possible to go to this person that shared this feedback with you and gave you their input and thank them and say, “I really appreciated you taking that minute to share that feedback with me”?

Kevin Pho: We’re talking to Alicia DiGiammarino. She specializes in health professions education innovation and research, and today’s KevinMD article is “Transform feedback into growth with the ARISE model.” Alicia, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Alicia DiGiammarino: Yeah, I think my take-home message is that feedback is a cornerstone of medical education. Receiving feedback is incredibly challenging, and that the receiver needs to take partial responsibility for turning the feedback into a productive conversation. And having a tool like the ARISE model, which is outlined in this article, can provide structure in the moment and help folks reflect on and improve their skills in receiving feedback.

Kevin Pho: Alicia, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Alicia DiGiammarino: Yeah, thank you. Thanks for having me.

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