Residents are constantly developing and refining their technical and cognitive skills. “But without structured, actionable feedback from mentors, residents can have difficulty knowing what specific adjustments are needed to improve,” said Jenny X. Chen, MD, EdM, assistant professor in the department of otolaryngology–head and neck surgery at Johns Hopkins School of Medicine in Baltimore. “Feedback is essential in clinical training because it supports deliberate practice—a focused, repetitive approach to skill building that’s fundamental in surgery.”
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January 2025In fact, Sarah Bowe, MD, EdM, program director in the department of otolaryngology–head and neck surgery at San Antonio Uniformed Services Health Education Consortium in San Antonio, Texas, believes that feedback is the single most important component of clinical training. She echoes the sentiment Jack Ende, MD, wrote in a JAMA article: “Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all,” (JAMA. doi:10.1001/jama.1983.03340060055026).
Added Michael Orestes, MD, program director in the department of surgery at Walter Reed National Military Medical Center in Bethesda, Md., “Without clear feedback, residents often feel uncertain about what they’re doing well and what needs improvement. Residents will struggle to improve, often learning more by trial and error.”
Feedback shouldn’t be confused with “assessment,” which is a more formal evaluation of knowledge, competency, or acquired skill to determine if a trainee has accomplished a milestone or certain level of achievement during their training, said Brad deSilva, MD, an otolaryngologist in the department of otolaryngology, and residency program director, laryngology fellowship director, professor, and vice chair for education at The Ohio State University Wexner Medical Center in Columbus, Ohio.
“Feedback is designed to help residents improve, while an assessment gauges a resident’s readiness for graduation or could be their score on an annual in-service training examination,” Dr. Orestes said. This helps to determine how a program is performing on certain educational topics.
Although hearing feedback can be difficult, ultimately trainees want to know when they did something wrong. “They appreciate being told to do something in a different way, as it may improve their skills or efficiency when performing a specific task,” Dr. deSilva said.
Nuts and Bolts
Given the importance of feedback, clinicians should be sure to provide it regularly and to tell residents to expect it. “If you only give feedback when something bad happens, then residents will dread a feedback session,” said Nausheen Jamal, MD, MBA, professor and chair of the department of otolaryngology–head and neck surgery at the University of Texas Medical Branch, John Sealy School of Medicine, in Galveston, Texas. “By knowing that feedback will be given often, residents can mentally prepare to hear what they should work on.”
When feedback is given irregularly, it can backfire and cause residents to feel like they’re in trouble—making it difficult for them to process feedback, Dr. Orestes added.
The most useful feedback is specific, timely, and delivered in a supportive manner. Specificity is key: Feedback should focus on clear, observable actions rather than vague or general statements, Dr. Chen said. For example, instead of telling a resident to work on their communication skills, provide concrete examples such as, “During your patient handoff to the nurse, you could have been more organized in delivering the patient’s post-operative plan.”
Dr. Orestes advised tailoring feedback to each resident; generic feedback isn’t very useful. For example, advice such as, “Next time, read a little more,” or “You just have to do more cases, you’ll get it eventually,” is too vague. Instead,