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AANS Neurosurgeon | Volume 29, Number 1, 2020

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Giving Constructive Feedback

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“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
 Maya Angelou

This famous quote serves as a straightforward summation of how individuals at all levels respond to various interpersonal interactions. This can serve as an easily-applied, fundamental principle in giving constructive feedback. Contextual considerations of who, when, where and what also critically influence the success of feedback to learners.

Understanding the learner’s perspective on the power dynamic between the individuals giving and receiving feedback is key in choosing effective language. For example, a comment from a department chair may devastating to a junior resident who has not securely established a record of competence or excellence, while the same comment to a chief resident or from an early career faculty may be significantly less anxiety-provoking. The pre-existing working relationship between the learner and evaluator inevitably affects the weight of the critique.  

It is helpful to preface feedback by announcing it, to facilitate acknowledgment by the learner that it occurred. Optimal timing of feedback is dependent on the situation. Constructive feedback on operative performance is ideally given in real-time, based on concrete examples, along with suggestions for improvement. If feedback is regarding charged circumstances, such as a complaint, allowing time for cool down enhances the likelihood of absorption. Constructive criticism, offered in this manner, is often received in a positive light. Constructive criticism, offered in this manner, is often received in a positive light.

In keeping with the evolution of medical student education away from the Socratic method, learners are increasingly averse to public criticism that may undermine their self-perceived stature; private discussions are less likely to be fraught with risk of offense. The culture of a program is linked to the ability to establish a safe environment for constructive feedback. At Johns Hopkins, trainees are encouraged to ask faculty for constructive feedback after every surgical case. The depth and connection of these exchanges are much more effective than the regularly scheduled written evaluations distributed at rotation end. Although summative evaluations provide a helpful overview, they are limited in their utility to provide concrete action items for targeted improvement.

In delivering constructive feedback, opening with positive content sets a reassuring tone and helps to put the learner at ease. It signals that the evaluator providing feedback has taken the effort to appreciate the positives; the trainee is not completely defined by deficiencies. There is zero tolerance for any comments that can be construed as disparaging, insulting, or harassing. Ending with positive encouragement and a concrete plan for accountability further emphasizes the recognition of potential for improvement. Such optimism is essential in establishing confidence in the learner’s ability and a longitudinal relationship of investing in the trainee’s development. As we have all witnessed, these relationships evolve into rewarding ones that continue to inspire us as educators, sparking feelings that endure, even if the recollection of what exactly we said is less than perfect.

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