My student's voice trembled as she answered my question. "How do you think you've done so far?" I'd asked her. We'd been together on the general medicine inpatient ward for two weeks—the midpoint of the rotation—and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance herself.
"Okay, I guess," she replied.
I waited to see if she had more to say. In fact, she hadn't done okay. She certainly wasn't the worst student I'd ever had, but she was easily in the bottom 10%. Her oral presentations were haphazard, often missing key details, their components often presented out of order (a traditional method exists for all storytelling in medicine, one that's designed for maximal efficiency and clarity and which, when abandoned, makes complex stories difficult to follow), her knowledge base was far below average for her level of training, and perhaps worst of all she seemed disinterested in her patients. I was concerned not just about having to give her a poor grade but about having to fail her. Her apparent lack of insight into the substandard level of her performance wasn't only a potential obstacle to her improvement, it was a potential obstacle to her developing into an effective physician.
GUIDING PRINCIPLES FOR GIVING FEEDBACK
First and foremost, always be clear on your reason for giving feedback, whether you're giving it to someone you supervise as a part of your supervisory responsibilities or to a colleague, a friend, or a child. It goes without saying feedback should never be used to benefit you but rather always to serve the person to whom you're giving it. Identify any self-centered agendas you may have—e.g., making yourself feel big by making someone else feel small—and ruthlessly cast them aside. Giving feedback is ultimately about mentoring. A truly great mentor always seeks to make his students better than himself and utilizes feedback as a tool to do it. With that in mind:
Of course, we all want to hear we're wonderful and without flaw. Hearing that we're not, or that our work product is not, always stings, even when we're genuinely interested in improving (we all secretly hope we have no room to do so). Here are some guidelines I try to remember myself when someone's giving feedback to me:
My student's apathy, it turned out, wasn't apathy at all. It was distraction. After I finished giving her detailed feedback, she surprised me by confessing that her mom was seriously ill. I suggested she consider taking a leave of absence, which two days later she agreed to do with some relief. That way she could both be with and help care for her mom, she said. I told her that medical school would still be waiting for her when she was ready to come back. Her mom eventually made a full recovery, and she returned to school to repeat her medicine rotation. I learned later from a colleague who supervised her the second time around that she did great, earning a grade of honors.
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