Feedback is crucial to medical students’ understanding of where they are in their training and what they need to do to improve their practice performance. The traditional model of feedback was one-directional: Someone senior told the learner what to keep doing and what to do differently.
But newer models have moved toward dialogue between the learner and the supervisor. A physician expert from the University of California, San Francisco (UCSF) discusses tips and strategies to help medical students get the most out of this collaborative approach, noting that it requires making adjustments before, during and after the learning situation.
Assimilating feedback is an essential skill in self-regulated learning, which is one way medical students can take control of their own education and constantly improve their skills throughout their careers. Following are three key ways to build incorporation of feedback into your training and help establish a practice of lifelong learning.
Have a plan. “Learners should anticipate getting feedback before they go into a learning situation, such as a session with a preceptor,” said Karen Hauer, MD, PhD, professor of medicine at UCSF School of Medicine, a member school of the AMA Accelerating Change in Medical Education Consortium. “Plan what you’re hoping to get out of that session so you can speak with the preceptor up front about what you’d like to learn.”
Feedback is often an iterative process, so include follow-up in your plan.
“After the learning experience, reflect on how it went,” Dr. Hauer said. “Ask the preceptor if your self-assessment is on track and what suggestions the preceptor has for you.”
Be open and willing. “Feedback is a gift, so it’s important to be open to it and to view it positively whether it’s reinforcing or constructive, which might be harder to hear,” said Dr. Hauer. “Of course it feels nice to get a pat on the back, but that doesn’t necessarily make you better.”
Also, embrace opportunities to get feedback, even though they may be unfamiliar.
“Many students will say they want to be observed, but when the time comes, it understandably makes them really nervous,” Dr. Hauer said, noting that students may go an entire clerkship without having anyone observe them. “So it’s important to find ways to counteract that nervousness and be willing to invite people to observe you.”
Ask for feedback, then ask some more. “We commonly hear learners say the feedback they received was too general, that it wasn’t really helpful,” Dr. Hauer said. “So if you hear, ‘Great job, you should keep working on your physical exam,’ or ‘You should read more,’ ask some follow-up questions to make it more actionable.”
In particular, Dr. Hauer suggests asking probing questions. Good examples include, “Can you tell me one thing I did well?” or “Can you tell me one thing you would recommend I do differently?”
“Another strategy,” she said, “would be to ask, ‘Can we talk specifically about my physical exam, and can you give me one piece of feedback on that?’”
Systemic changes needed too
Dr. Hauer noted that if feedback is to have a lasting impact on learners, changes to the clinical education workplace are also required. In 2016, with funding from the AMA’s Accelerating Change in Medical Education initiative, she and her colleagues at UCSF School of Medicine created a coaching program wherein students work longitudinally with a faculty member who does formative assessment.
“We’ve found that students have really adopted a feedback mindset, even if they started out hesitant to receive frequent feedback,” Dr. Hauer said. “They trust that the coach has their best interests in mind.”
“That longitudinal relationship is essential from a program design perspective because it helps complete the feedback cycle, which starts with identifying an area for feedback, then discussing it, then giving the learner an opportunity to try again, be observed and get more feedback. Feedback shouldn’t be viewed as a one-time thing.”