Timely Feedback – “Good Job” won’t make your job any easier!

*This one is not specifically, Pediatric related… but it is useful nonetheless!*
I just finished a shift that I was simply happy to survive without causing any harm to anyone, including myself.  At the end of the shift, I looked to my resident, who was able to weather the storm admirably, and I said, “Good job!” I certainly meant what I said, but, upon second thought, was what I said useful? Was my resident able to pick up on the nuance in how I said “good job” to glean from it that the medical decision making and management of the department was superior? I would like to think that all of positive and negative attributes were conveyed and understood in my efficient and intuitive announcement of “good job.” Unfortunately, I know that they were not.  I would also like to say that this is an aberration, and that I normally give well formatted feedback, but it is not.

Feedback is an integral part of not only the educational process, but also any leadership position.  So, whether you work in academics or community medicine, whether you are a resident or are a veteran physician, you will need to deliver feedback. From clinical techs to senior nurses, many people look to you to set the tone.  Having the mantle of leadership requires that you give feedback so that you can refine the efficiency of your department and improve everyone’s enjoyment of working.  {Yes, your shift can be enjoyable!}

Yet, even knowing that constructive feedback is of vital importance to everyone, I continually fall woefully short of providing it.  So, if you are in the same inadequate boat as I am in, please feel free to join me in an attempt to take simple steps toward improving feedback skills.  Here are a few points that I am going to personally focus on:

•    Put forth the effort:
Perfection will not be achieved initially, but often the simple effort will stand out in such stark contrast to what is typical that it will generate significant impact.

•    Be concise and objective:
Do not overwhelm people with feedback.  Much like how useful educational points are gleaned from succinct and timely pearls and not hour-long dissertations, our feedback will be “heard” more completely if it is delivered in concise, objective points.  This is one reason why the end-of-a-shift feedback doesn’t work as well (I often can’t remember anything to be concise about, so I speak in vague generalities).  When a moment arises for you deliver constructive feedback, do not paint elaborate pictures and scenarios: be succinct: be objective.  This will have greater impact and also respect everyone’s time more than protracted tutorials.

•    Be prompt:
Both praise and critiques are best received in association with an action, so we must be timely.  When you witness something positive, state that it was noticed and should be repeated.  When you witness something that needs correction, correct it and do not let it linger.  This also allows you to be objective because the facts are apparent and not diminished with time.

•    Ask for self-assessment:
Within the feedback process you have a natural ally: the person to whom you are giving feedback.  Many times the most critical assessment will come from the person giving self-assessment.  This will make your job easier!  To streamline the process, you can simply ask the person to critique the interaction (or the procedure, or the evaluation, etc) first.  You can then point out one or two concise points that need to be either commended or adjusted.  Then move on.

Yes, there are various methods for providing timely and meaningful feedback available in the literature.  Traditional evaluation forms, feedback card, electronic feedback forms, and end of rotation evaluations all have some benefit; however, the most significant impact will be elicited in person at the moment an action is performed.  What is discussed above is merely my attempt to make myself more accountable for giving useful feedback and a simple method to do so.  I hope that you can join me in putting forth the effort to deliver concise, objective points in a prompt fashion after eliciting self-assessment.

Reference: Wald, DA, Choo EK. Chapter 6: Providing feedback in the emergency department. In Practical Teaching in Emergency Medicine. Editor: Rogers, RL.  Wiley-Blackwell, 2009; pp.60-71.