From the moment I started medical school, one pendulum has swung and swung hard. It’s the pendulum of feedback. Back when I started, feedback was unheard of. As students, we suffered through abominable lectures. No one cared what we thought. Our only outlet was complaining to one another after class. Fifteen years later, it’s the opposite. We demand feedback. We hunt down feedback. We have 360-degree feedback. “Thanks for attending our free webinar, please click on the link to provide feedback.”
Feedback. Telling someone how you thought they did, and what they might improve upon. Of course, as an attending, I occasionally give feedback to medical students, residents, and fellows, and all three, give feedback to me. When I give a guest lecture or teach a course, I get feedback. I have given 10-minute talks at conferences, relying on handwritten notes, and gotten written feedback three times as long!
It isn’t unique to medicine, we collect feedback on everything. Too much ice in your boba tea? Better report that in online feedback. Even the Grand Canyon gets one-star reviews on Yelp.
I humbly submit that we have reached the point of too much feedback, and wish to offer six ways to course correct.
1. Nobody wants feedback from someone they don’t respect.
Medical students don’t respect all faculty, particularly those who are hurried, insulting, anxious, or indecisive. Similarly, no matter what someone’s title, rank, or age, there are some people whose opinions we end up valuing and others who we don’t. Folks who are fair, independent, and deliberative in their thinking are folks we wish to hear from. Yet, the feedback system rarely differentiates these people (only the comments sometimes betray if someone is thoughtful), and as a result, we get a lot of feedback from people from whom we don’t desire it.
2. You may not know what you need.
I recently gave a lecture to a trainee audience and spent considerable time on a statistical concept. One comment read: ‘Not sure we need to know this.’
I have no idea what the trainee will be tested on, so if ‘need to know this’ means will it be on a future test, they may be right, but I do know that if the person wishes to be a practicing doctor, knowing this will be a great advantage. I include it because I have relied on it so often.
Eventually, in your career, you reach a point where you know whether what you were taught was useful. It only took a few years into my career to realize that memorizing the Krebs cycle is not necessary for a practicing doctor (even if that doctor uses IDH inhibitors, as we do in oncology). But at the outset, it is often very difficult to know at the time what you need to know. Feedback doesn’t appreciate this.
3. We over-respond to it.
I have been a part of groups that solicit feedback, and enter into vicious response cycles. One year we do small groups; then, responding to feedback, we move to a didactic lecture; of course, then the feedback pushes us to return to small groups. Over the course of five years, we flip the classroom so many times, I feel like I just played five sets of tennis.
4. It can be non-representative.
A major bias of feedback is that people with strong opinions are disproportionately motivated to give feedback. A lecture can be well received by 95% of people, but if 5% really don’t like it, you will know. The loudest voices — not necessarily representative or right voices — can drive feedback. This is also true of online comments (see also #1).
5. It can waste energy.
Soliciting feedback takes effort, and often a lot of effort because folks don’t want to give feedback. Too much energy is spent collecting something people don’t want to give.
6. You may not be qualified to give it.
I cannot tell you how many times I have interviewed people for 20 minutes where I felt they were pleasant, but I had no idea how they would do at the job. And yet, feedback is demanded. Whether interviews predict job performance seems an irrelevant question to ask in a world that demands feedback. I have rounded with trainees for 2 days and been asked for feedback. The only feedback I have is, “I am not in a position to judge,” which sadly is rarely well-received.
Instead of our cultural obsession with feedback, I propose we think more about ourselves. Did you do as good a job as you wished? If you lecture to trainees: When did the student’s eyes glaze over? Could you have done anything to avoid it? Who is someone who does this that you admire, how might you be more like her/him?
And, for those who are training for a job, consider that you might not know what you need. Instead of feedback today, hold the idea, and circle back. It’s true that a lot of what you are taught could be presented better or might not be necessary — let them know what after you have a chance to figure it out. Sometimes feedback is best when you’ve had enough time to figure out what you want to say.
Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.
Source: MedicalNewsToday.com
