Feedback is instrumental to physician development during residency training. That’s why you need strong guidance on how to solicit feedback and apply it.
Reid Evans, PhD, an assistant professor and education director for graduate medical education, has worked to instruct both faculty members and residents on the mechanics of an effective feedback relationship. Evans presented on a curriculum he has developed on feedback literacy at the AMA ChangeMedEd® conference in Chicago.
Here are some key tidbits Evans offered that could allow resident physicians to enhance the way they receive and process feedback.
Start by asking
In working with residents and attending physicians in the graduate medical education setting, Evans has found that both parties can be hesitant to receive and provide feedback. Residents, Evans said, need to be made aware that they are well within their rights to ask for feedback.
As for getting the discussion going, Evans said there’s nothing wrong with keeping it simple.
“Starting the conversation is a basic step, and we try to give residents the confidence to do it,” said Evans, a faculty member at the University of Massachusetts Chan School of Medicine. “It can be as simple as saying, ‘Would you mind giving me feedback on the procedure we just did or my patient management plan?’—or whatever it might be that you are working on.”
Communicate your goals
Knowing what you want to take away from a given interaction or rotation allows for targeted feedback. To do that, communicating your goals to faculty members and attendings can be helpful.
“What facilitates that entire conversation is if the learner comes prepared,” Evans said. “Let’s say you are on the first day of a rotation. Read through the curricular description, look at the curricular goals and relate that to your ultimate goals as a physician.”
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Take action on feedback
Feedback related to your goals should inform the path toward improvement. It also could lead to setting additional or new goals related to self-improvement. From there, it’s time to process and use the feedback provided, Evans said.
“When you get the feedback and you renegotiate those goals, simply pause and say: This is my new goal. What is it that I can do to achieve this particular goal?” Evans said. “What does the time frame look like? What are the resources available to you? And if you aren’t sure what those resources are, how can you seek them? Can you speak with the attending physician? Can you speak with fellow residents? Do you need to do a literature review?”
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Seek feedback from multiple sources
In the interprofessional care era, opening your mind to feedback from other members of the care team, such as nurses and physician assistants, is important.
Evans said residents can often fall into the trap of seeking validation from a singular source, such as an attending physician, while limiting the value they place on feedback from other sources.
“When you do that, you are often limiting yourself,” Evans said. “Really, you should be taking into consideration feedback from many, many sources, and synthesizing that feedback together, because that paints the entire picture.”
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Not all feedback is valid
As feedback literacy is gained, Evans also highlighted that an awareness of the fact that not all feedback is created equal, is also an important lesson.
“You can’t take all feedback at face value,” Evans said during his presentation at the 2023 ChangeMedEd conference. “You are in some way analyzing and interpreting and validating that feedback because there may be times that you are not getting valid feedback—if an individual doesn't have the complete picture or they're not familiar with your goals. Then that feedback might not be as valid as it would be if it were from someone who has had more longitudinal exposure to your performance.”
Maximizing midyear reviews
While most feedback in residency comes in response to specific clinical cases, there are midyear reviews that are mandated by the Accreditation Council for Graduate Medical Education. These review sessions present an opportunity for residents to gain valuable insight on performance.
Heather Kowalski, MD, is associate program director of an orthopaedic surgery residency at University of Iowa Health Care, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Kowalski offered insight on how these meetings set the stage for improvement.
"We have a very specific document that they have to fill out ahead of time, which gives them an opportunity for self-reflection,” she said.
In those meetings, residents are encouraged to set SMART (that is, specific, measurable, attainable, relevant and time-bound) goals based on the feedback.
“We asked them to give us three to four specific goals,” Dr. Kowalski said. "We have found that it's much more structured, residents really get a lot from it. … Everyone walks away with clear, actionable steps for improvement.”
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
