In the broadest sense, feedback is how we learn about ourselves from our interactions, experiences, and engagements with other people. Receiving feedback often challenges how we perceive our self. Reflection and potential integration of feedback can truly help us improve and further both professional and personal growth. Our focus here is to provide tips on how to view our own perspectives, prejudices and biases when we both receive and deliver feedback.

 

1. Change your perception of feedback

To truly receive feedback, we must first recognize and manage any resistance we may have to hearing comments from others. Listening to feedback does not mean it is true or that we must change, rather it means we are prepared to actively listen and learn from the conversation. For example, one may be proficient at procedures or in handling confrontation, but an alternate technique or strategy may be very useful especially in a challenging case or situation. It is most helpful to engage in feedback with curiosity and confidence, not defensiveness. Listening to perspectives from the beside nurse or the medical student or the respiratory technician can also be very enlightening, and often uncover aspects of care that you may typically overlook. Thus, asking questions, eliciting feedback and learning why and how others complete tasks can provide valuable information. The goal is to find insight that might help you reflect and change, for in the end the key variable for growth is you.

 

2. Cultivate your identity

Our ability to metabolize challenging feedback is driven by the way in which we tell our identity story. It is important to cultivate a robust and complex identity. Those which are simple such as “I am good at procedures” are brittle and destined to fail. For example, if there is a procedure that you are not technically able to do or if you have a complication, then that challenges your identity. In this scenario, either the feedback gets exaggerated (you are a failure) or the event is denied (not your fault, blame lies elsewhere). Having an identity which is robust and realistically complex allows us to make specific shifts in assumptions that can improve our ability to stay balanced and learn from experiences. Specifically, it allows us to treat feedback as an opportunity to change and not as a threat to who we are. Fortunately, we can always learn to hold our identity in a way that makes us more resilient. In the end, we are human, so we must accept the following: we will make mistakes; we may have complex intentions; we may contribute to the problem.

 

3. Develop a growth mindset

The terms fixed and growth mindset were coined by Dr. Carol Dweck, an American psychologist, and they describe the underlying beliefs people have about learning and intelligence. Dr. Dweck studied how students respond to failure, and she observed how some students rebound while others seem devastated by the smallest setback. Those with a fixed mindset believe their abilities are preset and are less likely to flourish. Those with a growth mindset believe their abilities are malleable and are more likely to embrace challenges and persist despite failure. Publishing is a prime example where a growth mindset is needed. For example, it is rare to have a manuscript accepted by the first journal it is submitted to or accepted without any revisions. From publishing a case report to original research, the author must be open to feedback, and in the case of revisions, they need to respond with well thought out responses and edits as needed. Often the final product is enhanced or improved after revisions. Those not able to absorb or accept comments are unlikely to keep revising or submitting that manuscript, but those who continue to rise to the challenge eventually “find a home” for their work. A growth mindset allows you to incorporate feedback and use mistakes as a learning opportunity. As clinical educators, it is important to keep in mind that when we give feedback, we should utilize the same growth mindset. For example, “the way you handled the end of life conversation by allowing the patient and family to provide input first was both thoughtful and effective”. Or “the procedure was technically difficult due to complex loculations, but you approached it step-by-step and were able to place the chest tube.” Both examples emphasize the process or the effort from the learner as opposed to merely praising their intelligence or their procedural skills.

 

4. Recognize the different types of feedback

Feedback may be delivered with different purposes.

It can be a form of appreciation, and it is meant to motivate or encourage. With this type, it needs to be specific, and in the form that the receiver values and believes is authentic. Some may appreciate praise whereas others may prefer acknowledgement within the group, and others may value additional time off, titles or money.

    • Feedback can be given as coaching, and it can help increase knowledge or skill. It is important to recognize that all coaching has some element of evaluation.
    • Finally, feedback can be an evaluation, and it rates the receiver against set standards and ultimately informs decision-making.

As both the receiver and giver of feedback, one must be cautious about crosstalk. You may hear evaluation when appreciation or coaching was intended, so asking questions or engaging in conversation when feedback is delivered can help clarify the intent. Try to align and be thoughtful about what you need and what you’re being offered. Similarly as the giver of feedback, make sure to deliver in a time that the recipient will be engaged. For example, after a procedure I try to routinely give feedback to the learner, but I always introduce the topic and engage the learner to ask if they prefer we discuss now or later or in a different location.

 

5. Identify your emotional triggers

Certain triggers engender emotion within, and these allow our biases to emerge.

    • Sometimes, the feedback challenges what you believe is the truth. For example, your supervisor tells you that team members felt that you were not being collaborative, but you believe you are the most helpful and supportive person on the team. In turn, that feedback may be dismissed, for you believe it is off base or untrue.
    • At times, your relationship with the person giving feedback can also color your perceptions. For example, if your “work nemesis” gives you a compliment as a form of appreciative feedback, you consider that it must be a dig or an insult. You may have perceived that that person has always been against you or maybe recall a previous unpleasant interaction, so their feedback often gets discarded.
    • And finally, the feedback may challenge your identity as a person, and whether the feedback is right or wrong, it makes you feel overwhelmed, threatened, ashamed or off balance.

These emotional triggers are not obstacles because they are unreasonable, but they do prevent us from engaging skillfully in conversation. Receiving feedback well requires a process of sorting and filtering, so we can use the information that can be helpful and eventually reject that which is extraneous or does not fit.

 

6. Accept, clarify and thank.

There are three basic steps to receiving feedback.

1)  The first step is to accept. This demonstrates that you are open to and willing to listen. Have a conversation about the feedback. Use open-ended questions to facilitate a conversation.
2)  The second step is to clarify. Ask for specific examples so you can understand what the other person expects of you. You can also ask for tips or techniques.
3)  The last step is to thank the individual who delivers the feedback. Regardless of their approach, they took the time to try to help you.

It is important to be slow to speak and quick to listen, and not wear your emotions on your sleeve.

 

Feedback in the workplace plays a crucial role in developing tolerance, improving morale, aligning teams, and solving problems. This feedback may come in the form of an annual performance review, patient’s comments on a Press-Ganey score, or how your ancillary staff greets you. Receiving feedback well does not mean that you must integrate or commit to the changes suggested. It means that you can engage in a conversation skillfully. You can then make thoughtful choices on how to use that information and what you have learned. Receiving feedback means managing your emotional triggers, so that you can take in what the other person is telling you. Remember, feedback is how people perceive you, your actions, your behaviors and intentions, and these perspectives would be blind spots for you otherwise. Finally, be honest with yourself, continue to self-evaluate and constantly evolve.

 

 

Saadia A. Faiz, MD is a Professor in the Department of Pulmonary Medicine at the University of Texas MD Anderson Cancer Center. She also serves as the Associate Program Director for the McGovern Medical School at UTHealth Pulmonary & Critical Care Medicine Fellowship. She is a clinical educator with specialized expertise in procedural education. Her research interests include pleural disease in hematologic malignancies, as well as pulmonary vascular disease and sleep in cancer patients.