Commentary Corner: Feedback in Medicine
One of the most overwhelming aspects of becoming a medical student is adjusting to near-constant evaluation of your knowledge and skills. For many first-year students entering fresh from their undergraduate degrees, it is possible to have labored for 4 years in relative obscurity, scoring well on tests and putting together an impressive application. In medical school, however, even the most shy student will find that there are no hiding places. Patient interviews and physical examinations are practiced, often for the first time, under the watchful eyes of newly met classmates and instructors. Your first patient presentation will be given directly to a busy and scrutinizing attending. You will suture a real patient for the first time, with every stitch and knot evaluated by not only a physician but also a patient who may reluctantly note that your identification badge says "Medical Student."
However, the anxiety and fear of having an audience as you learn the ropes of medicine often pales in comparison to what comes afterward: feedback. Although feedback is a rather benign term in itself, it is no secret that, to many of the personalities attracted to medicine, feedback may seem like nothing more than criticism. The primary job of a medical student is to learn, and feedback is one of the main ways that a medical student does this. Although our efforts and viewpoints as students are beneficial to our teams and patients now, it is truly our future patients that we are serving by soaking up everything that we can during our 4 years of training. Anything that affects this learning process not only influences our own personal growth but also shapes our ability to optimally care for someone 10 years from that moment. Therefore, the ability to give and receive feedback during a medical career is of the utmost importance.
Feedback is a combination of not only the message but also the delivery. When delivered optimally, feedback offers a clear and constructive message that can be taken to heart and used as a springboard to improvement. When delivered poorly, it can cloud a truly constructive piece of advice and even invoke a defensive reaction that reinforces poor habits. Feedback has the ability to engage team members from the chief of the department to the medical student rotating through that service. That integration is why hospitals filled with doctors in training often have the best outcomes and allows the brightest and most patient-focused minds to develop into future leaders within clinical medicine.
As medical students, feedback is most often directed at us, as it should be. Feedback is perhaps our most powerful learning tool. It shapes our knowledge into a clinical toolkit that can heal and save lives, it passes on the intangibles of medicine, and it improves our skills in ways that no book or paper ever could. In every piece of feedback that we are given, no matter how it is given, there is useful information that can enhance our medical skills, and it is our responsibility to seize that opportunity.
As we progress through our careers in medicine, becoming residents and attending physicians, we will fill our minds with knowledge and skills that can be passed on to others. We will have the responsibility to teach and shape the education of those around us, and we will do this in the same way that others taught us: through direct feedback. Still, no matter what stage of training we reach, medicine is a field of lifelong learning. We will never cease to benefit from the comments and suggestions that our peers and superiors can offer us, regardless of what level we rise to in our careers.
Giving and receiving feedback is as much an ingrained art form within medicine as the physical examination or the patient interview and must be taught and regarded as such. It should be supported and reinforced in all stages of our career as an opportunity to improve, whether as medical students or as senior attending physicians receiving feedback from a colleague or even a patient. Embrace the feedback that you receive as a medical student; it is there to help you develop into a superb physician. Finally, make a commitment to mastering the art of giving feedback as you progress through medical school and beyond, because feedback is perhaps the true backbone of medical education.
- Institute for Clinical Research Education at the University of
Giving and Receiving Feedback
General advice on giving and receiving feedback with additional information on mentoring and an extensive list of internal and external resources.
- Johns Hopkins Medicine
A free online video that provides training in the knowledge and skills to provide effective feedback. Further resources on giving and eliciting feedback are also provided.
- University of Alabama at Birmingham School of Medicine
Lecture slides and handouts on giving feedback in addition to a useful list of resources, including Web sites, articles, and books.
- Journal of the American Medical Association
Feedback in Clinical Medical Education
A classic medical education article on the role and delivery of effective feedback in medicine drawn from strategies in education, business, and psychology.
- Academic Medicine: Journal of the Association of American
Feedback and Reflection: Teaching Methods for Clinical Settings
An instructive article on the role and use of feedback and reflection within clinical training and how they can be implemented most effectively.
Kevin T. Nead