provide a roadmap. For example, “You were able to dissect out the superior pole this time and identified the recurrent laryngeal nerve. For your next case, let’s see if you can find the nerve without as much assistance.”
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January 2025Timeliness is equally important; feedback should be given as close to the observed behavior as possible to make the connection between the action and the response more meaningful, Dr. Chen said. Deliver feedback using a non-judgmental tone and body language.
Ideally, find a private place where a resident won’t feel judged when receiving feedback, and where both parties can sit down, Dr. Orestes said. “Feedback should be more of a conversation and less one-directional,” he said.
In some instances, it may be okay to give feedback in front of peers. “It’s very dependent on the relationship of the people in the group,” Dr. Orestes said. “If several residents performed a case together and you have standard post-operative feedback, it shouldn’t be a problem. If you must convey very critical feedback, be sure to convey that in private. An exception would be to stop a hazardous action from being taken.”
Dr. deSilva agreed that providing feedback privately, in a calm setting, is typically best. But the flip side can be true as well—if someone does something well, don’t hesitate to highlight their performance and include faculty and peers so others can emulate their behavior or strive to do better.
Broaching the Subject
Starting a conversation about feedback on the right foot is key. Begin by setting a collaborative tone, asking a resident to self-assess with questions such as, “How do you think that case went?” This invites reflection and provides insight into their perspective, Dr. Chen said.
Dr. deSilva said that asking an open-ended question is often helpful, such as, What do you think you could have done better during this specific surgery or clinic day? “It’s often helpful to first understand a trainee’s perspective before providing your own assessment of their performance,” he said.
It’s also helpful to make feedback growth-oriented, rather than critical. For example, by saying, “Let’s take a minute to talk about how you can keep making progress,” you can make a conversation positive and forward-focused, Dr. Chen said. Keep feedback specific to actions or skills, rather than personal attributes, to help reduce defensiveness and make it easier to apply.
Dr. Chen tries to tailor her feedback to each learner after reflecting on her relationship with them as well as their experience and personality. While the core principles of effective feedback—being specific, timely, and constructive—remain the same, the way she presents feedback can change.
For example, some residents benefit from a more direct, no-nonsense approach, while others may need more encouragement and positive reinforcement to maintain motivation.
Dr. Chen also considers a resident’s level of self-awareness. For more senior learners who are already self-reflective, she relies heavily on open-ended questions that prompt them to assess their own performance. For those who are less confident or self-aware, she might provide more guidance upfront, focusing on strengths before discussing areas for improvement. “Ultimately, my goal is to make feedback actionable and ensure it resonates with learners, so I adjust my approach to try to meet them where they are in their development,” she said.
Overcoming Challenges
It can be difficult to ensure that feedback is well-received, especially if it addresses areas for improvement. Residents may feel defensive when receiving critical feedback, which can hinder their ability to process it constructively. “To overcome this, strive to build trust and rapport over time,” Dr. Chen said. “Fostering a supportive environment where feedback is seen as an opportunity for growth, rather than a personal attack, can reduce defensiveness.”
Another challenge is balancing the amount and type of feedback. Providing too little feedback can leave residents unsure of how to improve, while too much can overwhelm them, especially if it’s delivered all at once, Dr. Chen said. Prioritize the most critical issues and offer feedback that aligns with a resident’s developmental stage.
…strive to build trust and rapport over time. Fostering a supportive environment where feedback is seen as an opportunity for growth, rather than a personal attack, can reduce defensiveness. —Jenny X. Chen, MD, EdM