Giving feedback

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Yesterday, you heard one of your junior doctors, Jessica, berating at a colleague at work. It was a busy shift, and she was very stressed and under a lot of pressure. A 7 month old baby presented with bronchiolitis and her mother was struggling to manage at home. Jessica wanted to admit the patient to the ward, but the paediatric registrar on call did not feel admission was required. This interaction escalated and Jessica ended up being aggressive during the referral.

As a consultant, you will like have mentees to supervise. As registrars, we work closely with other, more junior, doctors. Whilst rocking the resus room is part of being a good doctor, actually being able to give feedback constructively and sensitively to our juniors is also a crucial part of being great at our jobs.

The aim of the feedback is to improve the mentee’s performance, not to decimate their confidence. They should go away feeling like they have a plan and are motivated to move forward. Here are our top ten tips for delivering your feedback well.

 

1: Introduce the conversation

“Jessica, do you have a few minutes, I’d like to have a chat to you”

That part seems easy enough. Jessica’s heart may be sinking as she wracks her brain for what might be coming. But you have made her aware that feedback is on the cards.

 

2: Be timely

We learn best through recency, and so feedback is better received closer to the incident. Getting feedback four months later isn’t that helpful. The exception to this is if it is highly emotional or highly charged. In that case it may be best to wait until you cool down.

In Jessica’s case, the incident happened yesterday, so the timing is good.

 

3: Do it in private…

Make sure you have a safe place and won’t be interrupted (particularly when sharing an office). It is humiliating to be criticised in front of your coworkers.

Bring Jessica into your office and make sure your colleagues know not to interrupt. Do not deliver the feedback to her in front of the rest of the department.

 

4: ….Or do it in public

Not all feedback is negative, although the most difficult types usually are. When praise is due, it should be heaped on people in public. Show your employees that you value their achievements. See Adrian Plunkett’s Excellence Reporting as a great example of this (which we have recently implemented in my own hospital ED).

 

5: Be specific

Stick to facts and give examples, and try not to exaggerate “all” or “never”.

Rather than ‘you tend to be rude to your colleagues in other departments” you could say “I have received feedback from an incident yesterday where you spoke aggressively and inappropriately to the paediatric registrar on call.”

State the impact of that behaviour “When you are referring patients, I want the receiving team to realise what a compassionate and competent doctor you are, and not to be distracted by you being aggressive during the conversation”.

 

6: Ask for their reaction

“Jessica, what are your thoughts on this?”

You need to give them a right to reply – is this a fair representation of what happened?

Expect defensiveness! Any normal person will feel affronted when given negative feedback by someone senior to them. They may deny, cry, or simply become enraged. Any of these is a completely normal response. And importantly, remember that there is no right time to give negative feedback. If Jessica gets angry, that is not because you didn’t pick the appropriate moment, it’s because it’s a shameful, embarrassing, awkward experience for her. It’s fine for her to get upset or defensive.

 

7: Provide suggestions

Consider SMART or GROW as frameworks for providing improvement suggestions. Focus on behaviours that can be changed, not personality traits.

“Jessica, can I make a suggestion? Next time you are a referring a patient, try to push all the other stressors going on in the department out of your mind. Focus on the fact that both you, and the receiving doctor have the patient’s best interest at heart. And try to see where they are coming from. Let’s meet again in two weeks to see how things are going.”

 

8: Be sensitive

Don’t be mean-spirited. You can be tough, but do not be mean. Telling someone they are “stupid”, “rude”, or “unprofessional” is not helpful.

The feedback isn’t about you making your mentee feel rubbish, it’s supposed to be for their benefit. If they feel hugely awkward or are made to feel stupid, then they are not going to be able to move constructively forward.

The feedback is for the recipient, not for you, so be sensitive to how your message comes across.

“Thanks for having this conversation with me, I know it was awkward for both of us”.

 

9: Keep it short

It does not take 20 minutes to provide negative feedback. The whole conversation can be tied up in 4-5 minutes. The truth is, Jessica just wants to get out of there and spend some time thinking about what you said/sticking pins in your voodoo doll. You need to let her do this without holding her hostage in your office.

 

10: Reflect afterwards

Although the focus of this feedback was for Jessica, you should take time to reflect on your feedback performance. Did it go as planned? Consider what would you do differently next time.

 

Jessica leaves your office with a flushed face. She is embarrassed, but she knew at the time that she had let the pressures of the department get the better of her. She can do better and will make sure her next referral is dealt with more appropriately so that at your next feedback meeting, things will be more positive.

 

 

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About 

Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts

12 Responses to "Giving feedback"

  1. Ian Summers
    Ian Summers 2 months ago .Reply

    Hi Tessa thanks for posting this.
    Agree with so much of what you said.

    When I get it wrong (in delivering feedback!) its often been because I either:

    Held back my opinion and left us both feeling awkward. Me: Don’t want to hurt feelings. Them: What on earth is this all about?
    Forgot to listen as well as talk.

    Me: I am just going to tell you what you did wrong
    Them: I know what I did wrong, and why and even what I should have done differently. I wish I could speak….

    and finally, awkwardness disappears if feedback becomes routine and expected. Make it part of your department or your teaching group, and role model being a recipient of feedback which means inviting it.

    Ian

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Agree Ian, regular feedback should be part of all supervision/training.

  2. Cian Brendan McDermott
    Cian Brendan McDermott 2 months ago .Reply

    Good advice Ian, make it routine and expected. That way it is not done i exceptional circumstances (usually after an adverse incident). Should be included as part of the (hidden) core curriculum

  3. Suzanne
    Suzanne 2 months ago .Reply

    Love this – especially the bit about ‘I want them to see you for the compassionate person you are’

  4. Chris Turner
    Chris Turner 2 months ago .Reply

    great post Tessa,

    I’d add to this that the way people accept feedback from you is also dependent on the reputation you have. If you are caring to staff (as well as patients) then they will listen to you much more easily than if they are expecting feedback to be hostile (or even weaponised). Rude Drs reduce the performance of those around them, and this includes the ability to learn from feedback.

    I sometimes think we spend a lot of time/resource working out how to give feedback but don’t spend time discussion how we receive feedback.
    For me, one of the strongest lessons regarding receiving feedback is that it is your choice what you do with it. You can choose to be a prover (and explain why the feedback is wrong/push it back) or you can choose to be an improver (and take it on board, think about it for a bit, and decide what you want to do with it). When we discuss this in our leadership teaching it is revelatory to most of the staff.

    thanks again for the great post and best wishes,

    Chris

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Great points Chris – sounds like a good idea for a follow-up post!

  5. Kirsty Challen
    Kirsty Challen 2 months ago .Reply

    I really like this Tessa, thanks.

    I would have one issue with the case as you described it – if I overheard the initial exchange yesterday, why did I leave this till today? (Different if it was reported to me by a 3rd party). As a supervising consultant I would expect to step in immediately – “are you OK Jessica, is there a problem I can help with?”. This would make her feel supported by her seniors, validates the concerns she had about the child and makes her more receptive to feedback on how to make the next interaction more productive.

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Thanks Kirsty – interesting point. Yes, depending on the situation (and certainly if it was getting out of hand) then stepping in at the time may be appropriate. However, there is also something to be said for giving the feedback in timely manner, but not in the heat of the moment. Jessica will already feel stressed at that time, so the negative feedback (even if done well) may not be best received/processed then.

    • Damian Roland
      Damian Roland 2 months ago .Reply

      That’s a good point Kirsty. One of the most difficult things to do as a junior consultant or registrar is not always about the feedback it’s about the intervention. I know this post wasn’t about the culture of care but too often we will too feel too uncomfortable about interjecting because of how embarrassing it will be involved to all involved. I have (admittedly not often) stopped a referral. I told the person on the other end of the phone I will phone them back and then had a chat with the person referring. Its really awkward but the conversation couldn’t have been allowed to continue. A difficult area to get right – I am sure I don’t!

      • Kirsty Challen
        Kirsty Challen 2 months ago .Reply

        Oops I don’t feel remotely embarrassed! Either my team has got the assessment wrong OR we have not communicated our concerns adequately OR the person on the other end is being an arse.

        All of those options require my intervention. Timing and extent of feedback then clearly need finessing depending on what I’ve found out.

        Clearly this isn’t a pure educationalist approach but a pragmatic take on balancing the shopfloor safety with (trying to) help the trainee. Kind of like a graded assertiveness approach?

        • Tessa Davis
          Tessa Davis 2 months ago .Reply

          I love this discussion, thanks for commenting. Intervention may be more difficult for some people – that rests on confidence and experience. It’s a different skill set, but still really important for all the reasons you describe. Lots to think about.

  6. Priti Khemka
    Priti Khemka 2 months ago .Reply

    Dear Jessica,
    I loved your post- I wish all mentors would read this. I had an experience as a new registrar in the neonatal department where an extreme preterm baby who failed extubation (I felt so at least) was reintubated by me. The consultant who also happened to be my supervisor walked in the NICU, was thoroughly disappointed and said that I should have called him and that I did not have enough experience with extreme preterms. This was shocking and humiliating for me and I could barely hold back my tears. It would have far more constructive to give feedback in his office, in a more encouraging way and to give me an option to say something in defence.

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