Getting the Feedback You Deserve
Justin Doroshenko, M.Ed., Paramedic, MS IV
University of New England College of Osteopathic Medicine
“Keep reading.” Nearly every medical student has probably received this piece of feedback in an evaluation at some point, but it’s not particularly useful feedback. So, how can you best set yourself up to receive actionable feedback from preceptors or other educators? There are steps you can take before, during, and after rotations to set you and your preceptor up to make the feedback process as useful as possible. It is also important that you learn how to receive feedback properly. Giving and receiving feedback are skills—and ones that aren’t taught as commonly, or as well, as perhaps they should be during medical education. Still, there are some easy steps you can take to up your feedback game:
1. Have a long-term plan.
At the beginning of a rotation, identify your areas of growth. These areas don’t need to be entirely specific at this point. They can be simple concepts, as you’ll have time to refine them as you encounter patients or situations that help narrow these ideas into more easily digested goals. Consider sharing these conceptual areas of growth with a clerkship director or preceptor so that they have a framework for evaluating you over an entire rotation or longer period of time. Don’t forget to regularly revisit these concepts during and even well after your rotation. Over time, you’ll find that your initial nebulous ideas can be broken down into more specific, measurable, and attainable goals.
2. Set your preceptor up for success… ask!
One of the more common pieces of advice medical students receive is to tell preceptors what they are working on at the beginning of a shift—and this is great advice. The pitfall for many students is not being specific enough. For example, instead of telling a preceptor you want to work on building a differential, consider telling them that you want to work on identifying life-threatening diagnoses that need to be included in a differential and the diagnostic tests with proper predictive values to help rule those diagnoses out. Ask your preceptor to pay attention to that part of your presentation or notes to get yourself specific and usable feedback.
3. Ask again!
At the end of a shift, ask your preceptor for feedback again if they don’t automatically give it to you. Remind them of the specifics you told them at the beginning of a shift. Their impression of your shift will never be fresher in their mind than it is right now.
4. Wait to respond. Ask for clarification.
Receiving feedback is a skill. Listen intently and actively. Ask questions if you don’t understand a piece of feedback. Remember that feedback can be on style or substance. Medical providers may have their own style of patient care or documentation; that may not end up being your style. That’s okay, but it is still important to learn other ways of doing things. You don’t have to incorporate every piece of feedback, but you should consider them. On the other hand, substance is the meat and potatoes of feedback. These are the things all medical students are learning right now: diagnoses and tests we didn’t know or forgot about, the mechanism of action at play when we give nitroglycerin for chest pain—you know, the things to “keep reading” about!
5. Don’t be defensive. It’s not personal.
Again, receiving feedback is a skill. Don’t immediately jump to your own defense about a piece of feedback—even if you don’t agree with it. Take some time to ponder why you were so taken aback by it. Were you embarrassed you forgot something? Is it a style piece that you don’t think fits your approach? Be mindful of your body language and facial expressions when receiving feedback. Try not to take feedback harshly because it’s probably not a personal attack. Feedback is rarely given harshly; it is more commonly received that way by students who (justifiably) want to look really good in front of preceptors.
6. Say thank you!
Seriously. Think of feedback as a gift. Appearing gracious will open you up to more feedback in the future and is often a memorable moment for those giving feedback. Receiving feedback well is necessary for lifelong learning, which is important for emergency physicians.
7. Follow up.
If you work with the same preceptor again, try to specifically incorporate the feedback you received from them previously. Remind them of the feedback you received, and tell them how you changed your approach or incorporated new information. If you work with a new preceptor, tell them about previous feedback you received when you incorporate it so they can nurture it. If appropriate, consider emailing the original giver of feedback to let them know you incorporated what they gave you and thank them again.
Does this all seem like a lot of work? It should! This is the time to put in the work. One could argue that most preceptors do not expect medical students to be perfect, but they do expect medical students to want to learn and grow. In outdoor education, there is a concept called “training to failure” where students are pushed to intentionally fail in a safe (sometimes simulated) learning environment. This stems from the idea that one cannot teach decision-making, but rather that it comes from repeated failure, learning from those failures, and practiced decision-making. Supervised clinical rotations are meant to be the safe learning environments of medical school, and receiving useful, constructive feedback after these moments of “failure” is the best way for medical students to begin learning this skill. Decision-making is arguably the most fundamental concept in emergency medicine. As medical students are pushed to take on more challenges during their clinical years, it is essential for them to prepare for failure and receive feedback that fosters the skill of decision-making.
Now, go keep reading.