Constructive Feedback Supports Lifelong Learning

Being a proficient doctor entails lifelong learning which requires reflecting on performance. MDA National outlines tips for seeking, accepting and providing useful feedback.

A recent Australian study found that medical students considered “teaching by humiliation” to be part of the culture in the medical profession. These findings raise concerns regarding the:¹

• impact on students’ learning and mental health
• contrast with and subsequent undermining of the formal professionalism curriculum
• future medical teaching workforce (people tend to do what was done to them as students thus perpetuating the culture)
• possible negative impact on patients who observe such behaviour including intimidating questioning styles or abusive language from teachers.

A medical professional who does not self-regulate, reflect on their performance and ask for help risks compromising patient safety.² Seeking feedback from others is dependent on:³

• a workplace culture that encourages and normalises critique from others
• open and supportive relationships based on mutual respect and trust
• lowering individual emotional barriers (trainees who fear appearing incompetent may not seek feedback, and supervisors who are uncomfortable with the emotional reactions feedback can elicit may not readily give feedback).

Cultivating a lifelong learning ethos starts early

Encourage medical trainees to seek and accept feedback, and to reflect on their performance. To achieve this, consider the following principles for providing constructive feedback:

• Set realistic goals and objectives based on what the individual is expected to learn and what they want to learn. The trainee will be more likely to act on the feedback and less likely to take comments personally.^{4, 5}
• Make feedback a regular occurrence⁵ and act immediately where necessary and appropriate.⁴ Embed an element of reflection into all learning opportunities and set aside time for observation to enable meaningful feedback.
• Ask the trainee for their self-assessment to promote reflective practice.⁵
• Be specific.⁴ Validate feedback by basing it on direct observation with specific examples of behaviour that can be modified.⁵
• Provide reinforcing feedback. Find reasons and take opportunities to recognise positive behaviours and excellent performance. This reinforces current desired behaviour and inspires people to want to do better.⁶
• Use positive communication strategies. Body language is important as well as a respectful and supportive tone. Ensure the session is a two-way conversation.⁵
• Reflect on your feedback skills.⁵

Use the DASR script as a template for expressing constructive feedback⁷

• Describe the behaviour you observed using factual information, sensory language (e.g. what you saw, heard, counted), and statistical information (e.g. quantity, frequency, duration).
• Acknowledge your reactions to the situation or impact of their behaviour without making any judgements or assumptions about the person, e.g. “I felt…”
• Specify different desired behaviour.
• Reaffirm the individual’s worth and ability to correct their behaviour, e.g. “I am confident you can improve on…”.

Receiving feedback continues throughout your career

Accepting advice from colleagues can be a challenge for any doctor. Here are some tips for seeking, receiving and handling feedback:⁸

• Improve self-assessment. Proactively identifying and being aware of your own strengths and weaknesses can make receiving feedback less abrasive. Assess performance by breaking down tasks into different components, e.g. if reflecting on how things went in a specific patient encounter, consider the steps involved such as building rapport, history taking, etc. This helps to reveal specific areas that may need attention.
• Be open to receiving feedback. Everyone has blind spots about their abilities. Being receptive to others’ observations provides the opportunity to discover strengths and areas of improvement.
• Proactively ask for feedback. Medical workplaces are often busy and feedback can be overlooked.
• Control your emotions. Many people find receiving feedback emotionally challenging. Focusing on seeing it as an opportunity for development and thinking about it objectively can help.
• Clarify feedback you do not understand. Not everyone is good at providing feedback, and general comments such as “good job” are not helpful. Ask questions to discover the details and initiate a productive conversation.

Explore the topic further

• Do you find it difficult to accept feedback from others? Review tips for effectively reflecting on your performance: ncbi.nlm.nih.gov/pmc/articles/PMC4116619.
• Are you a clinical mentor? Consider best practice for providing feedback: ncbi.nlm.nih.gov/pmc/articles/PMC3399605.
• Are you involved in General Practice training? Discover strategies and tools to minimise medico-legal risks with MDA National’s General Practice Supervision and Patient Safety workshop. Check out Upcoming Events on our website. You can request a session if an event is not scheduled in your area or is not at a convenient time for you.

Gemma Brudenell
MDA National Education Services

References

1. Scott K, Caldwell P, Barnes E, Barrett J. "Teaching by Humiliation" and Mistreatment of Medical Students in Clinical Rotations: A Pilot Study. Med J Aust 2015;203(4):185e 1–6. Available at: mja.com.au/journal/2015/203/4/teaching-humiliation-and-mistreatment-medical-students-clinical-rotations-pilot
2. Byrnes P, Crawford M, Wong B. Are They Safe in There? Patient Safety and Trainees in the Practice. Aust Fam Physician 2012;41(1/2):26–9. Available at: racgp.org.au/afp/2012/januaryfebruary/are-they-safe-in-there/
3. Delva D, Sargeant J, Miller S, Holland J, Brown P, Leblanc C, et al. Encouraging Residents to Seek Feedback. Med Teach 2013;35(12):e1625–e31
4. Duffy K. Providing Constructive Feedback to Students During Mentoring. Nurs Stand 2013;27(31):50–6.
5. Ramani S, Krackov S. Twelve Tips For Giving Feedback Effectively in the Clinical Environment. Med Teach. 2012;34(10):787–91. Available at: lo.unisa.edu.au/pluginfile.php/699009/mod_book/chapter/75798/12.tips_effective.feedback.pdf
6. Knesek G. Creating a Feedback-Rich Workplace Environment: Lessons Learned Over a 35+ Year Career in Human Resources. The Psychologist-Manager Journal 28 September 2015
7. Hathaway P. Giving and Receiving Feedback: Building Constructive Communication. California: Crisp Learning, 1990
8. Algiraigri A. Ten Tips For Receiving Feedback Effectively in Clinical Practice. Med Educ Online 2014;19:1–5. Available at: ncbi.nlm.nih.gov/pmc/articles/PMC4116619/