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Osler Reincarnated

August 18, 2019
by Mark David Siegel

Hi everyone,

We are perfect. So sayeth MedHub. We are all-knowing, selfless, master-clinicians. We are peerless educators. We have reached the pinnacle. We are Osler reincarnated. Let us all bow and curtsy, and exit stage left. Let the audience roar.

Okay, I’m exaggerating, but not much. We’re stingy with constructive feedback. Instead, we shower each other with “Keep up the good work!” “Amazing!” and “Keep doing what you’re doing!” Let no pointy objects near our ego balloons.

Can we all agree that everyone can improve? I have nothing against praise, but have any of us achieved perfection? Don’t we all need constructive feedback?

I certainly do. Almost every Sunday, one of my best friends critiques my Program Director’s Notes. From misplaced commas to ambiguous phrasing, she lets me know. It’s one of the reasons I love her.

I’ve gotten great feedback from many of you. With your help, I’m learning to focus my attention on a finite number of projects instead of taking on everything at once. For example, this year I’m focusing on creating fall retreats, improving the PCC experience, and ensuring workplace safety. Other ideas will have to wait. I’m also working to be less controlling (though it’s hard; I’m an intensivist). I’m learning to let Residents, Chiefs, APDs, and other faculty work to develop curricula, improve teaching conferences, and enhance rotation structures. They need space to be creative and develop their careers.

We all need specific feedback, which is why “keep doing what you’re doing” fails. Encouraging words are nice to hear, but do they really help you grow? What does “keep doing what you’re doing” even mean? Do you really want to max-out your performance at the level of an August intern?

I’m not sure why we hesitate to give constructive feedback, but I’ll propose two factors. First, we want to be encouraging and worry—wrongly—that giving constructive feedback does the opposite. Second, it can be hard to come up with suggestions for improvement, until we remind ourselves what truly stellar performances look like. Neither concern should hold us back. We can encourage people and give constructive feedback at the same time. Here are some suggestions, and I’m sure you can think of more:

For interns:

  • Don’t ask the resident or attending what to do. Just say what test you want to order or what treatment you want to start. If you’re wrong, we’ll tell you.
  • Put your stethoscope directly on the skin and not over the hospital gown (that’s ruffling cotton you hear, not crackles).
  • Proofread your notes before you sign them.
  • If you finish your work, see if your co-intern needs help.
  • Call consults early in the day.
  • Ask questions
  • Try presenting from memory- it’s easier than you think and it will streamline your presentations
  • Circle back to patients at the end of the day (they’re aching for you to return)
  • Slow down when you speak to elderly patients; many of them are hard of hearing.

For residents:

  • Bring articles to rounds
  • Make more two-minute teaching points
  • Pitch in when the intern is overwhelmed.
  • Try not to interrupt presentations unless it’s crucial to do so
  • Time rounds so we can get to Report on time
  • Give the interns space to create their own diagnostic and treatment plans
  • Keep the nurses up to date on the plan
  • Keep primary care physicians in the loop (they’ll be grateful)
  • Role model pristine presentations and note writing
  • Question consultants if you disagree with their advice- respectful debates lead to better care

For attendings:

  • Remember to discuss goals for rotations
  • Plan a consistent time to run the list at the end of the day
  • Help us find the spleen
  • Let residents lead rounds
  • Share pearls from your years of experience
  • Let the intern take the lead at the bedside
  • Give mid-rotation feedback so trainees have time to improve
  • Except in crises, don’t tell residents what to do- they learn more when they devise plans themselves (you can always exert executive privilege, but most of the time, they’re right)

So here’s my request. If you really can’t resist, go ahead and say “keep up the good work.” But don’t stop there. No one comes to Yale to coast, and none of us are even close to reaching our true capabilities. We’re not Osler reincarnated. Not yet.

Constructive feedback is a gift. Please give generously.

Enjoy your Sunday, everyone. I’m heading outside.


Submitted by Mark David Siegel on August 18, 2019