Feedback…It’s a Critical Procedure!

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George Willis
George Willis
Asst. program director and medical student director, which means he loves to teach at all levels! Lover of all things MedEd. Focus on feedback and teaching on the run. Former D1 football player but now lives out his football dreams vicariously through his sons.

The Pre-brief

Think about this scenario.  You’re listening to your intern discuss a patient with a consultant.  They are doing a good job until you hear them say “Sure, we can get an MRI of the brain.  We will call you when the results are back,” and then hangs up the phone.  Your eyes meet and the look of disappointment on your face is very evident.  As you are getting ready to deliver feedback, a patient with respiratory distress rolls in and your intern quickly rises and runs into the room to assess the patient.  

A very important concept with the delivery of feedback is making sure that everyone involved is in the position for it to be the most beneficial.  There are a lot of potential points for failure, which don’t benefit the giver or the receiver.  First, the provider needs to deliver the feedback in a manner that the receiver will receive it.  The receiver may perceive any feedback as a criticism and, if taken the wrong way, could lead to adverse feelings about the provider making future interactions strained.  Second, the receiver needs to be in the right mindset to receive feedback.  A learner that is distracted or apprehensive about receiving feedback will likely not receive the underlying message.  However, it may be difficult for the provider to accurately ascertain the mindset of the learner.  

Therefore, providing feedback needs to be approached in a manner similar to a procedure.  Before doing any procedure, you have to prepare so that everything is optimal.  The algorithm I do before every procedure is the same: ask myself if the procedure is necessary, prepare the room, prepare the patient, and prepare myself.  Consequently, I use a similar methodology when I’m preparing to deliver feedback.

1) Is the feedback necessary?

Similar to thinking about whether intubation or placing the central line is necessary, we must consider if feedback is necessary.  This question may seem easy to answer.  However, providing feedback may not be necessary, even for behaviors that may be deemed negative.  For example, if the intern above recognizes the disappointment in your face and immediately calls the consultant back after stabilizing the patient with respiratory distress, feedback here may not be necessary.  As long as they understand why they’re calling back and are not doing it simply because they know you’re upset.  Additionally, feedback may be beneficial for positive behaviors.  A common misconception is that feedback is simply supposed to be corrective only.  However, reinforcing good behaviors is another very effective feedback modality as well.  Positive interaction with a patient.  Teaching the medical student.  By reinforcing the positive, hopefully, this will lead to continued similar behaviors in the future.  Either way, the goal is to assess if the behavior warrants feedback.  If no, continue looking for other feedback opportunities.  If yes, move to the next question.

2) Room preparation.  

Prior to performing any procedure, I make sure that my room is set up with everything I need.  Consequently, I do the same thing before providing feedback.  Is this the right place to deliver the feedback?  Some learners will be embarrassed if they are criticized in the presence of others, whether it is their peers, their supervisors, or their learners.  So the middle of the work area may not be the ideal place.  Certainly, in front of the patient is also not necessarily the best place for critical feedback.  However, these may be opportune venues for reinforcing positive behaviors.   Especially if the behaviors may benefit other learners who are within earshot.  Therefore, consider the type of feedback you’re giving and the appropriate venue.  For example, I often provide constructive criticism in an office or empty patient room to provide privacy and give them a chance to provide any insight into the framework of the behavior.  

3) Patient (Receiver) preparation.

As I prepare, I want to make sure the patient is in the prime position for me to perform the procedure.  Are they prepped?  Is the bed in the appropriate position?  Likewise, the receiver must be prepared to receive feedback.  Is this the right time to provide feedback?  Literature suggests that timely feedback is best as the receiver is more likely to remember the behavior.  If it was just after a bad outcome, such as a difficult interaction with a consultant or a complication from a procedure, the learner may be figuring out how to emotionally cope with the bad outcome.  Piling on constructive criticism at the time when they are dejected may not allow them to fully process the feedback.  Or worse, it may cause them to fully break down emotionally.  In this circumstance, allowing them some time to process the bad outcome on their own will allow them to appreciate any feedback that you have to give.  Immediate feedback is really only necessary if the learner is about to do something dangerous.  So allowing time is often in the best interest of everyone.  

4) Provider preparation.

The last thing I prepare for performing a procedure is myself.  After I’ve set everything up in the room and got the patient in the appropriate position, I put my gown and gloves on and get myself in the right mindset to perform the procedure.  I do the same before providing feedback.  I ask myself if I am in the right mindset to provide feedback.  If I am angry at the behavior that I just witnessed and it is evident, any feedback I give will be perceived negatively and may affect the way the receiver feels about me and any future interactions.  Therefore, sometimes YOU as the provider of feedback need to take some time to emotionally distance yourself from any feedback you are about to provide.  Take a few minutes to calm down.  Count to ten.  Punch a pillow.  Go to the ambulance bay and scream.  Release that tension and then go back and provide the feedback in a calm demeanor so that the message will be perceived the way it is meant to. 

The Debrief

As with any procedure, good preparation helps lessen the likelihood of complications.  Similarly, these preparation steps allow the feedback to proceed with the lowest likelihood for complications.  Therefore, consider these preparation steps before your next shift when you may have to provide feedback. 

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