#233 Giving Effective Feedback with Drs. Abby Spencer and Alia Chisty

September 21, 2020 | By Paul Williams

Is the feedback sandwich good enough to feed your brain hole?

Listen to our medical education heroes, Dr. Abby Spencer, @abbyCCim (Cleveland Clinic), and Dr. Alia Chisty, @aliachisty (Penn State Health), school us on how to give effective and meaningful feedback! Topics include: the ADAPT framework, how to give difficult feedback, keywords and phrases when giving feedback, how to avoid gender and racial bias when giving feedback, giving feedback to your peers and how to solicit effective feedback as a team leader.

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

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Credits

• Written and Produced by Paul Williams MD, FACP
• Cover Art: Paul Williams, MD, FACP
• Infographic: Edison Jyang
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guests: Abby Spencer MD and Alia Chisty MD

Sponsor

Provider Solutions & Development

Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

How to Claim VCU CME Credit

Time Stamps

• Sponsor – Provider Solutions & Development www.psdrecruit.org/curbsiders.
• Sponsor – VCU Health Continuing Education
• 00:30 Intro, disclaimer, guest bio, pun
• 04:00 Guest one-liners, Picks of the Week* (see links below)
• 10:25 Sponsor – Provider Solutions & Development www.psdrecruit.org/curbsiders.
• 11:00 Case from Kashlak, Feedback definitions
• 15:00 Addressing perceived barriers to feedback
• 31:45 ADAPT model of feedback
• 38:10 Addressing potentially gendered feedback; 
• 42:45 Giving feedback to those who lack insight
• 48:29 Feedback and racial bias
• 52:25 Giving peer feedback
• 58:10 Tips for soliciting feedback as a supervisor
• 69:05 Does giving difficult feedback mean people won’t like you?
• 75:10 Take home points and Outro
• Sponsor – VCU Health Continuing Education

Feedback Pearls

1. The intent we have and the intent the learner believes we have when giving feedback is key
2. The ADAPT (Ask-Discuss-Ask-Plan Together) model can be used to develop shared learning goals
3. Be mindful of giving gendered feedback. Women and underrepresented minorities are often described by personality traits rather than by competency
4. Have a colleague read your letters and try to guess the gender of the trainee as a check on gender or racially biased language use
5. Use discussion of public perception of a learner as a means to address feedback in someone resistant or with limited insight
6. Consider the D’s in a learner who is struggling: Divorce, Disease, Drugs, Distraction, Depression
7. Start rotations by telling learners what you would like feedback on for your own performance
8. Ask trainees what pet peeves they have in general about rounds – probably some of them will apply to you

Feedback notes

Feedback basics

• Feedback defined: (Ende, 1983) Information describing a learner’s performance in a given activity that is intended to guide their future performance in that same or an interrelated activity
• Specific information about the comparison between a trainee’s observed performance and a standard given with the intent to improve that trainee’s performance
  • Intent we have and intent the receiver believes we have when giving feedback is key
  • Intent to reach the goal that the learner has set for themself
  • Feedback can also be thought of as the pathway to mastery (Brown 2018)
• Learners are often looking for appreciation, coaching, or evaluation (Stone and Heen 2014)
  • Gauge what element the learner wants, and try to provide it
• Barriers to feedback include time limits, the desire to be liked, and fear of hurting other people’s feelings
  • Honest is kind and clear is kind (Scott 2019)
• Caring is providing honest and direct feedback
• Someone’s inability to deliver good feedback should not interfere with your ability to take feedback
• Formative feedback: Ongoing feedback that is designed to promote continued growth
• Summative feedback: More formal, evaluative feedback that summarizes performance
• Give feedback in a private space with sufficient time to do it properly
• It can be helpful to ask your learner what their feedback should focus on prior to beginning a rotation

Feedback and bias

• Females may be described in more communal terms 
• Women are often described by personality traits, and men by competency (Rojek et al. 2019) 
• Perceived positive personality characteristics are often more stereotypically masculine (e.g. “calm, decisive, confident leader”) —Mueller et al. 2017.
• Behaviors can be compared against standard competencies to mitigate against potentially gendered language
• It can be very helpful to have someone read your evaluation and guess the gender of the subject
• Underrepresented individuals in medicine are also more likely to be described by personality traits (Rojek et al. 2019) 
• One study showed “competent” is a commonly used word in Black learners , compared to “standout” in white learners (Ross et al.  2017) 

Advanced feedback skills

• Abby Spencer’s amazing advice for providing feedback to learners who may lack insight about a deficiency: “The magic word that grants entry into the absence of insight is ‘perception’”
  • “I know you care, but there’s a perception among your nurses, peers, etc. …”
  • “How do you want the nurses to describe you?”
  • “You won’t get to [your] goal if the perception is X – how can we change that perception together?”
• Kashlak Pearl: Consider involving human resources for professionalism concerns
• Think of the D’s in the struggling learner: drugs, divorce, distraction, disease
• Come from a place of curiosity, not judgement

Seeking feedback as a supervisor

• Similar to asking learners about their learning goals, lead with what things you are hoping to improve on at the beginning of a rotation
• One way to frame is: “Pretend your best friend is coming on service tomorrow–what can I do to make their experience better for them than I did for you?”
• Ask what you should keep doing, and what you should do differently
• Ask about what pet peeves your learners have experienced on rounds in general. Probably some of these apply to you!
• Consider asking senior faculty to observe you on rounds
• Get involved in national programs, like the  SGIM TEACH program 

Links*

1. Radical Candor (book)
2. Host (film)
3. Percy Jackson & The Olympians: The Lightning Thief movie 
4. Hamilton on Disney Plus
5. Her (film)

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will demonstrate effective techniques to deliver and solicit meaningful feedback.

Learning objectives

After listening to this episode listeners will…  

1. Discuss the definitions and terms used to discuss feedback.
2. Deliver effective feedback that is concordant with the learning goals of their trainees.
3. Address potential perceived barriers to feedback.
4. Utilize the ADAPT framework to partner with their learners and develop shared goals.
5. Develop strategies to mitigate against using gender- or racially-biased narrative language.
6. Deliver feedback to learners with limited insight by leveraging the impact of perception on achieving goals.
7. Solicit effective and meaningful feedback despite being in a position of authority

Disclosures

Drs. Spencer and Chisty report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Williams PN, Spencer A, Chisty A, Brigham SK, Jyang E, Watto MF. “#233 Giving effective feedback with Abby Spencer and Alia Chisty”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date September 21, 2020.

References 

1. Ende J. Feedback in Clinical Medical Education.  JAMA.  1983. . [https://pubmed.ncbi.nlm.nih.gov/6876333/] 
2. Brown B.  2018.  Dare to Lead.  Random House.
3. Stone D and Heen S.  2014.  Thanks for the Feedback.  Penguin Books.
4. Scott K.  2019.  Radical Candor.  St. Martin’s Press.
5. Fainstad T et al.  Feedback can be less stressful: Medical trainee perceptions of using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) framework.  Cureus.  2018. [https://pubmed.ncbi.nlm.nih.gov/30906679/] 
6. Rojek AE et al.  Differences in narrative language in evaluations of medical students by gender and under-represented minority status.  J Gen Int Med.  2019.  [https://pubmed.ncbi.nlm.nih.gov/30993609/] 
7. Mueller AS et al.  Gender differences in attending physicians’ feedback to residents.  JGME.  2017.  [https://pubmed.ncbi.nlm.nih.gov/29075375/] 
8. Ross, DA et al.  Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations.  PLoS ONE.  2017.  [https://pubmed.ncbi.nlm.nih.gov/28792940/]