How to Provide Better Feedback to Fellows

Adobe on Alameda, with Sage (oil), by Ralph C. Williams Jr.

Although providing feedback is often discussed as separate from teaching, it is the most important teaching we do as clinician-educators. Whether attending on the inpatient consult service or precepting in the clinic, providing direct feedback is the most effective way to help fellows advance their skills.

Feedback, however, is only as good as the giver makes it and only as welcome as the receiver perceives it. It’s all too easy to disregard the recommendations of an untrusted source, and learners often aren’t sure when they’re receiving feedback, despite teacher perceptions of giving frequent feedback.¹

Fortunately, both giving and receiving feedback are skills that can be honed over time. In this overview, we provide you with the tools to create a feedback culture, deliver effective feedback, clarify the distinction between formative and summative feedback, and shed light on the best way to solicit feedback from others.

Promote a Feedback Culture

Culture is critical. Getting it wrong will stifle feedback and learning, but getting it right can catalyze growth. Each faculty member has a responsibility to promote a culture of feedback.

Adopting a growth mindset is essential to this process. This concept encourages individuals to frame challenges as opportunities, seek modifying feedback and recognize that intelligence and talent are dynamic, not defining, qualities.² The alternative is a fixed mindset, in which challenges are avoided, modifying feedback is resisted, evaluations are perceived as judgments, and intelligence and talent are viewed as static, defining features.

Bearing this in mind, you should help struggling fellows see failure as opportunity and acknowledge your own areas of weakness to normalize the growth process (e.g., “I remember how much I struggled with learning the synovitis exam when I started fellowship.”). Recognizing and admitting one’s own shortcomings promotes humility, flattens hierarchies, forms connections between team members and lays the groundwork for a healthy feedback culture.

Recently, feedback literature has shifted its focus from the giver of feedback to the feedback dyad (giver plus receiver), highlighting the relationships essential for effective feedback. Telio et al. identified parallels in psychology, in which research on the therapeutic alliance demonstrated that “expert insight alone (i.e., unidirectional therapist to patient communication) is insufficient to evoke change in patients” and that it was the “client’s perception of the relationship” that was most important to determining if a therapist could promote change.³

Telio et al. elaborated on an analogous “educational alliance” between super­visor and trainee, in which the quality of the relationship is examined from the trainee’s perspective and rooted in a shared understanding of performance, goals and sub­sequent action plans.³ Understanding that successful feedback is far more about your relationship with a trainee than it is about the exact words and messages you deliver is an essential and underappreciated perspective for all supervisors.

To be a great teacher and mentor, it can be enormously helpful to adopt the skills and practices of a coach, who is adept at drawing out the best in even the most advanced learners. Coaches of athletes or musicians provide incessant feedback, which is rarely perceived as a value or character judgment, largely because coaching connotes shared goals, mutual engagement and partnership with a dedication to performance maximization.⁴ The coaching model encourages the learner to reveal, rather than hide, weaknesses and to identify opportunities for improvement, and the coach tracks progress and provides guidance to promote improvement.

To implement these ideas, meet with your fellows and co-create goals before you begin working together. Promote the concept that you are forming “an alliance” or that you are serving as their “coach.” Make clear that your priority is their improvement, and that feedback is a critical component. Start a dialogue and negotiate a plan forward. Both you and your fellows will be grateful that you did.