A resident physician in the emergency department begins an encounter with a patient who presents for flank pain. Shortly into the history, a nurse interrupts and requests that the resident immediately attend to a critically-ill patient who just arrived. The resident excuses herself and rushes to the resuscitation bay. Later, the resident returns to find that the patient with flank pain has been sent for an ultrasound by an attending physician who completed the evaluation. Angered, the faculty member begins to lecture the resident on efficiency and task-switching. She barks at the resident, saying, “you dropped the ball on this patient… you clearly should have taken the time to place orders before doing what the nurse wanted… you simply don’t get it… you don’t understand how to function in this emergency department.”
In THE FEEDBACK FORMULA: Part 1, Giving Feedback, we learned the 6-step method to providing feedback through the lens of relationship building and behavior change. But what if, as in the case above, the supervising physician isn’t trained in providing effective feedback? How might the learner redirect the feedback encounter in a more positive direction?
Deconstruct events using The Feedback Formula to defuse a tense situation and salvage the supervisor-trainee relationship.
The Feedback Formula… from the trainee perspective:
- Ask permission: “Could you spare a moment to provide specific feedback on how I might improve my performance?”
We have all been on the receiving end of poorly-delivered feedback. Supervisors may enter these discussions at times of great urgency, stress, and emotion. Asking permission to enter a feedback conversation with a request for specific, behavior-based suggestions can redirect the supervisor in a positive manner. Truly frustrated supervisors will use this opportunity to delay feedback until the end of the day or a later scheduled meeting, simply to allow for a cooling-off period. The smart faculty member will recognize such a request as a chance to change course and save face.
- State the intention: “It wasn’t my intention to delay the care of our patient. I certainly want to meet your expectations and succeed in this role.”
Feedback hurts because it is never our intention to perform poorly. Students, use these discussions as an opportunity to simply improve performance. Manage your defensiveness and state your desire for formative feedback.
- Name the behavior: “The nurse interrupted my interview with the patient because she needed my immediate help. I trusted her. I returned to continue with our patient as soon as I was able.”
Clearly state the facts of the encounter from your perspective. Don’t over-explain yourself, as you may come across as defensive. Instead, describe your behaviors, motivations, and challenges. These will help the supervisor understand your point of view and decision-making.
- Describe the impact: “I don’t have a good sense for how to navigate competing demands for my attention and time. Can you suggest ways in which you would have managed this situation differently?”
Asking for feedback is a sign of strength, not weakness. Own what you can and cannot control, recognizing the scope of these limitations. Acknowledge the outcome of the encounter and its impact on you as the learner. Too much feedback can overwhelm – and there will be no further learning.
- Inquire about the faculty member experience: “I’m curious what you observed or experienced from your perspective. What improvements could I make for next time?”
Effective behavior change will only grow from a shared understanding of the encounter. Listen for the nugget of truth. What is the piece that will improve performance? Address any mismatch in expectations and identify opportunities for better team dynamics.
- Identify the desired change: “Let me summarize what we discussed. You suggested that the next time I am pulled away from a patient encounter I should ask the nurse to find my supervising attending and ask for assistance. I must share patient care duties within our team and not feel responsible to do everything on my own. It is ok to ask for help.”
Be kind to yourself. Reframe as: ‘What is the new or revised action that will ensure success in the future?’ Maintain both a gift and a growth mindset. Move towards problem-solving and away from blaming.
Spencer Arnold, BS is a medical scribe in the Department of Emergency Medicine, Stanford University.
Lisa Stefanac, MBA is Co-Founder and Partner of KSE Leadership LLC in San Francisco, CA. She focuses on leadership development, team effectiveness, and talent management for small and large companies, and across industries. Lisa is on staff at Stanford Graduate School of Business, where she facilitates interpersonal dynamics, coaching, and mentoring courses for the MBA program.