I adore deconstructed cannolis. Is there anything more scrumptious than sweet, tangy ricotta cream, scooped up with a crunchy cookie, especially when the cream is laced with chocolate bits? To fully appreciate a cannoli, to reach cannoli bliss, we must contemplate each component and the unique contribution it makes to the dessert.
The same goes for feedback. Well, sort of. Maybe “delicious” isn’t the best way to describe feedback, but feedback does go well with a French Roast, and it can be deconstructed.
Feedback consists of three components: appreciation, coaching, and evaluation.* We appreciate people when we acknowledge their efforts. The Chiefs do this every week, for example, with their “Shout Outs.” We show appreciation when we thank teammates for helping out when it’s busy, when we congratulate a resident for running an effective code, or when we praise an intern for reading an EKG at Report. Appreciation warms our hearts. It tells us our efforts are noted. It reminds us we’re valued members of a community.
We coach when we show colleagues ways to improve their skills- for example when we remind learners to place their stethoscope on the patient’s skin and not over the hospital gown, or to avoid copying forward old information in their notes, or to try picking an antibiotic before asking the ID fellow. Senior residents and attendings need coaching too. If no one tells them, they may not know they’re interrupting the interns too often on rounds, or that they’d be more effective teachers if they explained their decisions. We all want to grow professionally, but without coaching, our growth will be stunted.
Evaluations tell us where we stand in our career development. ITE Scores help you assess your knowledge base. They tell you if you’re behind, on target, or ahead of expectations. Milestone evaluations accomplish the same task; they show you where you stand on the road from new medical school graduate to independent internist. At your biannual meetings with your APD-advisor and with me, we'll tell you if you’re on target for promotion or graduation. What we say generally shouldn’t be a surprise, but it’s important to hear explicitly that you're progressing as expected.
Deconstructing feedback helps us avoid disappointment and misunderstanding. It can be frustrating when you want coaching but all you get is encouragement- like when your resident says “great job” but you were hoping for efficiency tips. Similarly, it can be deflating when you’re starved for appreciation but all you get is a list of ways to improve your notes.
Feedback can be confusing if we don't choose our words—or listen—carefully. Appreciation and coaching should not be misconstrued as evaluation. When an attending acknowledges your hard work, he isn't sending a secret signal that you’re on target to graduate; he's showing appreciation. When the MICU attending corrects your ABG interpretation, she isn't saying you're bad at critical care; she’s teaching. By deconstructing feedback, we can ensure we’re delivering and hearing messages as intended.
Feedback is like food. Without it, we starve. But when it has all the essential nutrients, we grow. Effective feedback depends on a generous helping of encouragement, sophisticated coaching, and well-timed reassurance. And when it’s artfully prepared—delicious even—we can all flourish. We’ll call it feedback bliss.
Enjoy your beautiful Sunday, everyone. I'm taking a long bike ride before diving back into those residency applications.
*To explore feedback further, read this marvelous book: “Thanks for the Feedback: The Science and Art of Receiving Feedback Well” by Douglas Stone and Sheila Heen.