Giving feedback

I found this article in the BMJ, which I thought was vaguely useful. http://www.bmj.com/highwire/section-pdf/9102/10/1

It’s also made me think a bit more about the practice sessions that I had in the run up to the disaster exam, and the the lovely exam.  Basically, the point of doing clinical practice sessions is to get feedback from other people! Otherwise, you might as well just be at work*.

So, here are my tips on giving/receiving feedback, preferably without turning into a speechless, gibbering wreck (ok, that might just be me…)

Give…

1. Do it.

This is practice for the exam.  It’s not an exercise in sycophancy.  It’s not much good if you’ve spent 7 minutes examining someone’s nervous system, only to be told that “that was fine”.

2. Constructive criticism

It’s supposed to be constructive: so instead of just saying how not to do something, suggest an alternative.

3. Be specific

(See the “that was fine” comment above: what was fine???)

Instead of saying that someone has a good rapport with their patient, think about how they’ve achieved that.  This is for two reasons: 1. it’s more useful for the person who’s just put themselves through the trauma of being watched by 6 of their colleagues, 2. it’s more useful for you to think about what you can learn from each other.  Which leads me onto my next point…

4. Use the group!

I (very personal view here) don’t think this should be an individual vs. the group scenario.  I think it’s really useful if an individual’s examination is used as a starting point by the group for further discussion and suggestions.  Time is limited: think about your own CVS examination; what do you do differently and why; discuss it.  Use the expertise that you have = each other.  Much more useful than a textbook; usually easier to understand; and definitely easier to find the right information quickly

…and receive

1. Listen to the feedback

It’s not personal.  It’s not about what someone thinks of you as a doctor (I have to keep telling myself this).  It’s not about your ability to lead a crash call, or make a diagnosis, or talk to your patient.  It’s about demonstrating that in the exam.

2. Decide what’s important

Listen to the feedback, but you don’t have to let it change your practice.  Everyone has a different style and way of doing things.  (One of the criticisms I had in the “good” exam was my technique for examining ankle reflexes: it was how I’d been shown on a clinical course by a neurologist.  You can’t please everyone all of the time 🙂 )

3. Don’t dismiss it: take some time

I find the whole thing of having someone else watch me really, really upsetting.  I hate it.  Generally, I am in no fit state to listen to anyone else once I’ve finished.  Go away.  Have a coffee/glass of wine/gin/box of chocolates.  Watch a silly film/Scrubs/Cardiac Arrest (if you’re feeling really grim).  Then think about what the feedback was again.  You might still think it was completely wrong.  Repeat the Scrubs/gin/chocolate again, and think about it again after a week.  It might make more sense.

Basically, the feedback is more important than the practice.  You work a 48 hour week; you practice all the time.  Thinking and reflecting about your practice (see, the management speak is taking over my blog!) is what makes the difference.

At some point, I will share my personal disasters from the exam/practice sessions.

The disaster exam was almost two years ago… I still can’t quite face thinking about it!

*you can revise/practice at work as well.  It’s just not as predictable – might write about that later on

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