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Safety in the Absence of Danger

March 04, 2023
by Mark David Siegel

Hi everyone:

In many ways, MedHub is hardwired, so no matter what I say today (or previously), peer evaluations will remain confidential for now. In full disclosure, the APDs and I can see evaluators’ names, but residents can’t. By seeing names, leadership can follow up with evaluators when we need more information to help residents grow.

I understand the reasons for confidentiality. By withholding names, some residents may share observations they would otherwise suppress to avoid retaliation or avoid hurting relationships. But such concerns should be outliers.

Let’s leave aside for the moment whether evaluations are ever truly confidential, particularly when detailed. The problems stemming from confidentiality far outweigh the benefits, fostering an odd notion of safety in the absence of real danger.

Confidentiality perpetuates the misperception that “constructive” feedback is in reality “destructive,” meant to tear someone down rather than build them up. Confidentiality also perpetuates the notion that constructive feedback is something to fear rather than value. Why else withhold your name? Confidentiality promotions the nihilistic notion that we’re unable to critique with kindness.

Confidentiality routinely hurts feelings when residents read criticism that a peer was unwilling to share in person. Imagine learning that a co-resident thought you could improve your efficiency, teamwork, or communication skills but didn’t feel safe enough to tell you directly. If you wanted to create a system designed to undermine trust, this would be it.

Sometimes, we need to protect confidentiality. If a resident believes a colleague has treated them disrespectfully or has discriminated against them, they deserve the opportunity to report their concerns privately. Similarly, if a resident has a credible reason to fear retribution, they need a safe pathway to share concerns with residency leadership or the GME office (the GME anonymous hotline is 203-688-2277). This confidential pathway is available to any of you, but these concerns are distinct from the way we should approach routine performance reviews.

One of our residency’s missions is to foster advocacy, which demands courage. When you sign petitions, write op-eds, and speak up at meetings, you buttress the credibility of your views and the strength of your convictions. The same is true when you write peer evaluations, seeking to improve colleagues’ skills. Fear of retaliation is immeasurably outweighed by the benefits of identifying yourself. Moreover, comments made openly are more likely to be thoughtful and helpful rather than nasty and harmful.

Regardless of whether you choose to join the small band of residents who sign their evaluations, please be sure that what you write in MedHub mirrors what you say in person. Highlight what your co-resident did well and how they can improve. Be specific: don’t tell co-residents to “keep doing what they’re doing” or suggest there’s “nothing” they can do differently, which is self-evidently untrue. We all need to grow, and we depend on colleagues to show us how.

In this residency, we are committed to professional growth, which requires transparency, honesty, trust, and openness the others’ perspectives. For all these reasons, I hope you will stand up and identify yourselves, because that’s the best way to provide feedback to your peers and community.

Enjoy your Sunday, everyone. I’m headed out for a ride on the Farmington Canal.


P.S. My twin brother, Ed, and I are turning 60 on March 13. Here we are last night, celebrating with our 99-year-old mom.

Submitted by Mark David Siegel on March 05, 2023