#48 Channeling the Afterglow, not the Aftermath: Tips from AIMW25 for Navigating during and after Feedback Conversations with Drs. Reeni Abraham and Liz Petersen

April 30, 2025 | By Era Kryzhanovskaya

Audio

Transcript available via YouTube

Join us as we discuss best practices for the feedback conversation and the post-feedback period, with Dr. Liz Petersen and Dr. Reeni Abraham that we had the opportunity to sit down with in person at the Alliance for Academic Internal Medicine’s AIMW25.  REMAP your feedback conversation by using clinical skills you are already comfortable with from sharing difficult news with patients.  These techniques will help guide your learners to success!

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Meet our Guests:

Reeni Abraham, MD holds the Nadine and Tom Craddick Professorship in Medical Education and is the Associate Vice Chair of Undergraduate Medical Education in the Department of Internal Medicine at UT Southwestern Medical School in Dallas. Clinically, she is an academic hospitalist and works at the palliative care clinic for the county safety net hospital system, Parkland. She is passionate about medical education, specifically professional identity formation, learner assessment, and communication skills. 

Liz Petersen, MD, MPH, FAAP is an Instructor of Medicine at Harvard Medical School and the Program Director for the Brigham and Women’s/Boston Children’s Internal Medicine and Pediatrics Residency. She works clinically as a combined Med-Peds hospitalist and has a special interest in medical education, learner assessment and feedback, and global medical education. 

Supported in Partnership with Alliance for Academic Internal Medicine

Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Alliance for Academic Internal Medicine AIMW25 reflections
• What sparked their interest in the topic
• Why are feedback conversations hard
• Introduction to the learning cycle as part of feedback conversations 
• REMAP
• Expect Emotion
• Focus on MAP
• Take-home points
• Outro

Afterglow Pearls

1. While feedback classically focuses on the experiencing part of Kolb’s learning cycle, navigating the post-feedback period well allows learners to take advantage of and capitalize on the other parts of the learning cycle: reflecting, thinking/conceptualization, experimentation. 
2. As related to feedback, REMAP stands for Reframe the feedback, Expect emotion (and respond empathetically), Map out career/professional goals, Align with the learner, and Plan post-feedback action steps.
3. “Feed-up” includes framing or sharing expectations/learning goals for learners to have buy-in on what you’re going to observe and offers transparency on what’s important. Feedback is the obtaining information on current performance; this is the answer to how am I doing or how is it going.  Feedforward is how we use this info to improve performance going forward.

Afterglow Notes 

We sat down for a conversation with Drs. Abraham and Petersen who, along with Drs. Nora Osman and Maddie Rodriguez, presented at AIMW25 a workshop entitled: “Afterglow or Aftermath? Navigating the Period after Feedback Conversations.”

The post feedback period is a time where “magic happens” in learning.  An educator has an opportunity to engage a learner to make a change that aligns with their goals and career and as an important component of their learning and growth.  This episode has many parallels to patient care, and Dr. Abraham reminds us that this educator checking in with the learner after the conversation is akin to us as clinicians asking how patients are going to follow up based on the conversation in clinic that day or for them to make follow up appointments to check back in on how things are going relative to the plan made in that visit. 

The Learning Cycle

Most feedback occurs in the experiencing section of Kolb’s Learning Cycle.  Navigating the post-feedback period using Drs Petersen and Abraham’s approach takes advantage of all parts of Kolb’s Learning Cycle, beyond experiencing, to include reflecting, thinking/conceptualization, and experimentation (Kolb 1984).  We learn by reflecting on the experience (not just by experiencing it); we engage in sense-making: how do I use this information and how do I integrate this into my life?  How did I process this? What is the affective overlay? Change (and integration of feedback) happens when we consider what is our perception about what just happened and how does this align with identity.

Challenges to Feedback

Drs. Abraham and Petersen remind us that feedback conversations are hard for us as educators because of time constraints around them and due to our concerns around other people’s feelings–we worry about upsetting others and how people are going to take the feedback points. 

There are challenges to the sense-making of learning and feedback for a learner: considering the feedback giver specifically. What is your relationship to them and how are you perceiving their comments? Do you feel that person cares for you and where the feedback came from? Does the relationship matter? Focusing on the post-feedback period and talking after the initial conversation helps build the relationship and make this more bidirectional.  Another challenge is that learners can feel lost; it can be overwhelming to receive modifying feedback, have to make sense of it, tie it back to goals in the moment, and consider what next steps to make. Without a learner figuring out their “why” (or an educator helping) to pull on the mission/vision, there is less of a chance to learn, integrate, and make meaningful change. The authors present a modified approach to REMAP (used in patient care for serious illness communication as part of the VitalTalk teaching, Childers 2017) focused on application to feedback conversations:

REMAP

In Drs Petersen and Abraham’s model , REMAP stands for Reframe the feedback, Expect emotion (and respond empathetically), Map out career/professional goals, Align with the learner, and Plan post-feedback action steps.

Reframe

Diving deeper, this means reframe the situation by sharing a headline of the feedback/overall message with an explanation of why it matters.  Reframing also involves the interpretation of feedback to determine if it does or doesn’t serve us. The learner/receiver can take a step back to consider what the nugget is in the feedback; we can always gain something from it. Formally, the “reframe” section can involve the educator using the Ask Tell Ask approach: Ask what they heard or took away or their perception of interaction (“What did you take away from the last  feedback conversation we had?”). Tell information and/or share what you saw (“Based on review of the clinic feedback,…”). Ask for permission to follow up through email or additional discussion (“Is it okay if we schedule a discussion a few days from now?”).

Expect Emotion 

Educators can use the NURSE mnemonic also from VitalTalk: Name, Understand, Respect, Support, Explore the emotion.  The guests recommend that the educator can also share that they get overwhelmed when receiving feedback to normalize the emotional response.  Offer ways to acknowledge, support, and respect the learner’s efforts: “I see how hard you’ve been working to improve”.  Respond to emotion with empathy.  Consider the parallel with patient care: when we share bed news, we don’t expect patients to process information right away (in fact we expect them to hear nothing the first or second time).   “We can take time, talk about it in a few days.” Give time to process, expect emotion, and return to the conversation at another time.   

Mapping Goals, Aligning

Parallelling the patient care literature where MAP starts with mapping patient values and goals, the application for feedback starts with ensuring the educator and learner are starting from a shared goal– what do they want to improve?  How is this going to help them grow?  

The A in MAP stands for aligning which involves summarizing and reflecting back what you’ve heard to this point including goals and values (Natesan 2023).  Find a common goal and highlight how the suggested changes will help them in their next rotation or block, or let them shine on future sub-i? 

Feedback, Feedforward, Feed up

These terms go in a loop: framing or sharing expectations/learning goals are part of the Feed up. This allows the learner to have buy-in on what you’re going to observe and offers transparency on what’s important.  Feedback, as the second part, is the obtaining information on current performance; this is the answer to how am I doing, how is it going? Feedforward is how do we use this info to improve future performance? 

Plan as Final Key Step

This is a great chance to revisit the conversation to see what the learner took away from that initial reframe and define where the learner carries the plan forward to facilitate on-going growth (Liakos 2023). This can look like asking them to send an email in the next few days to see what they heard or scheduling a follow up meeting, with the specific anticipation that you will discuss overall goals and how the specific feedback fits in.  

Planning can also include the learner creating a SMART goal: something small/focused, actionable, and observable to get iterative feedback on that area.  Sometimes, learners may have trouble creating their own goals, so you as educator can help them with sense making and give them next steps: can ask them when thinking about their next rotation, how can this help you? Consider their goals from positive and optimistic framing. How can you integrate this feedback?

Pausing and allowing time for REMAP makes the conversations more productive; you hear their values, what the learner wants to take away, and how you can check in on what things they identified to see if there was a change, get more buy-in, and continue to see the meaning-making. This is an opportunity to instead of adding more time, redistribute your time as an educator; you are already doing this work with patient/relationship-centered communication in the clinical setting, and now you’re applying the skills and employing these strategies with learners!

Take home points

Dr. Abraham shares that the feedback conversation only concentrates on a small piece of the learning cycle; if we don’t focus on the post-feedback period, we are missing the opportunity to harness where else learning occurs (reflection, integrating into practice).

Dr. Petersen notes that we need to expect emotion in feedback; this is a normal part of the conversation, and we should expect it going in. Allow space and time for reflection to let things sink in, and then make a follow up plan and move through it to get to the change/end product. 

Links

1. Dr. Abraham and colleagues created a bedside tool for faculty and residents to provide better feedback to learners on cognitive and professionalism skills: notebook. 

Goal

Listeners will learn approaches to successfully navigate situations that happen after the initial feedback conversation

Learning objectives

After listening to this episode listeners will be able to …

1. Review the challenges and opportunities in the post-feedback period
2. Describe approaches to fostering a growth mindset as part of navigating the post-feedback period and for learner development
3. Identify strategies to support learners in processing and applying feedback after conversations and after the post-feedback period

Disclosures

Drs Abraham and Petersen report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Kryzhanovskaya E, Abraham R, Petersen L, Heublein M. “#48 Channeling the Afterglow, not the Aftermath: Tips for Navigating during and after Feedback Conversations. The Curbsiders Teach Podcast. https://thecurbsiders.com/teach April 30, 2025.