Written By: Kathryn E. Coan, MD and Matthew Anastasi, MD

   

Feedback is crucial to enhancing individual and team performance. It is a key component, not only, in medical education, but in everyday situations.  Quality feedback has the ability to shape behaviors, foster an environment of continuous learning, and improve performance.  However, to achieve these outcomes, feedback needs to be something that happens on a regular basis and is specific, non-judgmental, and honest.  In this article, we discuss what feedback is as well as what it isn’t. We also aim to provide some tips for giving feedback that can be used across a broad spectrum of environments.

What is feedback?

Feedback is information received about an action as it relates to a goal. Take, for example, hitting a golf ball.  If the goal is to hit the ball straight, and instead the ball goes left, the outcome (the ball going left) is information about your golf swing.  If a lecturer gives a long, tedious presentation with 200 slides about chronic kidney disease and 50% of the class falls asleep, the class’ reaction can be considered feedback about the presentation.  In these situations, feedback is nonverbal. It is not subject to interpretation or judgment.  The ball went left; the students fell asleep.  Feedback is information received about behaviors, not about the individual. Giving verbal feedback should also be about offering information about an action as it relates to a goal, but for most of us giving quality, feedback is quite challenging.  In part, this is because we frequently conflate feedback with formal evaluations or informal advice.  While feedback is essential to both these entities, it should not be confused with them.

Evaluations tend to be summative, formal, and doled out in the form of a rating, ultimately placing a value judgment on the actions performed.  Whether it is a grade, a point rating, or a salary adjustment, generally speaking, an evaluation labels something as positive or negative.  Feedback, on the other hand, is formative rather than summative, can be offered less formally than an official evaluation, and comments upon specific objective behaviors without judgment. Although, evaluations often include objective feedback and may reference how an individual responded to feedback in order to give justification to the evaluation they should be viewed as complementary rather than synonymous.

Advice is also regularly confused with feedback.  Advice is intended to provide suggestions for improvement. However, discussion of a specific action (feedback) is different from advice on how to improve an action.  If the lecturer did not see half the class fall asleep and was then advised to be more engaging, this advice may appear unsubstantiated and therefore might be ignored or disregarded.  Advice without feedback as the basis for the suggestion can lead to confusion, irritation, and in some situations, can limit autonomy necessary to enhance an individual’s growth.

Below are examples of feedback, evaluation, and advice in response to various situations:

Situation

Evaluation

Advice

Feedback

A lengthy lecture

I would give that lecture 2/5 stars.

During the lecture, you should be more engaging.

I noticed when you got to slide 48 that 14/25 students were asleep

Dissection of an artery that starts to bleed and isn’t easily controlled

 That was a bad dissection

You should have maintained exposure of the artery when it was bleeding by replacing the retractors here and here

When you began the dissection, you had clear exposure of the artery, but it became much more difficult to see after the bleeding started

A patient response to a provider

The provider was only partially engaged. Yelp 3.5 stars.

You shouldn’t use the computer when talking to patients.

A patient tells you, when you are not looking at the computer, it makes me feel like you are listening more closely

 

Remember, feedback is a lot like coaching. It is meant to provide specific information about observable behaviors that can help someone make improvements.  It also expresses interest in another person’s actions, which can help build a relationship.  Many times, people are unaware of how their actions affect others. Therefore, providing people with this information is critical for personal and professional development.

Tips for giving feedback

-Be specific

This can be accomplished by providing tangible examples instead of vague observations. For example: “Your presentation was confusing” is different from “I was confused about the discussion section of your presentation. When you began discussing the results of a different paper, I did not understand how it related to your conclusion.”

-Base feedback on observed behavior not judgment or assumptions

This can avoid some of the emotions associated with “negative” feedback.  Feedback should focus on the action not the person. For example: “You are not engaged” versus “I observed you using your phone while other learners were presenting on rounds.”

-Be timely

Remember, feedback is different from an evaluation.  Feedback should be specifically related to an observed action, and the closer the feedback is given to this action the easier it is to relate back to the time the action occurred. The power of feedback to affect change is lost if it is not given in a timely manner.

-Clarify goals

Even if you give specific, observed feedback, in a timely manner it is likely to be ineffective if you are not on the same page as the recipient. Having clear, shared, goals will make your feedback more effective and valuable.

-Make it a two-way conversation

Feedback should be a dialogue rather than a monologue, as the other person’s perspective may provide insight into the reason behind the observed action. This can also help avoid assumptions about the behavior and allow for more tailored feedback

-Be consistent

Feedback is a continuous process like coaching. It needs to be given on a regular basis and labeled as feedback to be effective.

-Be Honest

Regardless of the profession, no one ever improved upon their performance without truthful feedback.

-Be Open to receiving feedback yourself

Feedback is ongoing and interactive. Every time that you give feedback, you receive verbal and nonverbal feedback that can help you improve the quality of feedback you give next time.