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 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, 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, 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…
Ensure 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 challenging 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 average person will feel affronted when given negative feedback by someone senior to them. They may deny, cry, or become enraged. Any of these is an entirely normal response. And importantly, remember 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 a shameful, embarrassing, awkward experience for her. It’s okay for her to get upset or defensive.
7: Provide suggestions
“Jessica, can I make a suggestion? Next time you refer a patient, try to push all the other stressors in the department out of your mind. Focus on the fact that 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 will not 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 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 on Jessica, you should take time to reflect on your feedback performance. Did it go as planned? Consider what you would 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 ensure her next referral is dealt with more appropriately so that things will be more positive at your next feedback meeting.
Giving feedback – Lori Chait at DFTB18
When we learn about feedback, it is often from the side of the wise expert, the person giving it. Whilst they might be very good at what they do, it is worth considering how the person on the receiving end feels. In this talk from 2018, Lori Chait, a paediatric trainee*, reflects on what it is like to be on the receiving end and how we might do a better job.
This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘, we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is about acquiring scientific know-how and looking beyond a diagnosis or clinical conundrum at the patient and their families.