I've been doing this wrong for decades.
Thankfully, a podcast finally taught me the difference between critiques that shut people down and those which build people up.
Intro
It was not long ago that I was in the same boat as many of you, struggling to be known for my area of expertise, feeling like my contributions were lost in the shuffle and unsure how to advance my career.
I spent a lot of time juggling tasks that didn't quite align with my goals and I missed out on a lot of precious moments with my family, but I've had my aha moment and now I'm all about channeling my energy into activities that truly propel me forward and bring me happiness. I'm Stacy Ishman and I'm the host of the medical mentor coaching podcast. I'm a full professor who's built clinical research and administrative programs while mentoring and coaching young academic physicians from medical school through their first 10 years of practice.
Please join me as we dive into all things career advancement, finding your niche and working towards that elusive work-life integration.
Podcast
Hello and welcome back to the medical mentor coaching podcast. I'm Stacy Ishman and I'm going to be talking to you today about how to get people to do what you want or how to give effective constructive criticism.
I have been doing it wrong for decades and I'm going to tell you that my wife and my kids have been very kind to let me know that the way that I try and help them learn how to do things better has not really been well received. And I'd be completely honest. I could never understand why my good intentions weren't understood until now.
Now I've been teaching and mentoring coaching for 24 years, but I only learned this week how to effectively give constructive criticism. And I learned it on a business podcast from Layla Hermosi who talked about the difference between critiques that shut people down and those that build people up. So I'm excited to talk to you about this today.
What's even more interesting to me is that she framed it in such a way that I realized my standard method of giving feedback probably makes people feel insulted and shut down instead of helping them get better. And gosh, this was absolutely not what I intended to do, especially when I was giving this kind of feedback to my kids or my wife or my trainees or really anyone. So when I was in my training, I had a lot of great mentors and colleagues and many of them were thoughtful and kind. It's how I picked my specialty.
But the standard method of feedback and surgery was mostly negative with a lot of comments that sounded like you need to do a better job of X or Y and that's the PG version.
Now, in an attempt to do an even better job, I tried to take on a better method.
And so at the time that I was training, maybe 20 years ago, we talked about how we could pivot to the feedback sandwich. And I think we're all familiar with this where somebody comes in and says something great. And then they say, Oh, but this thing that you could do better.
And then they tell me something else that's great. And that sounds nice.
But first of all, you could see it coming from a mile away.
And the second is it really felt inauthentic or manipulative. It wasn't a great way to foster trust. You just got worried every time somebody said something good that it was going to be followed with something bad.
And it also dilutes the impact of your message. I wasn't listening to the positive message. If I'm a negative person, I'm waiting for the negative, or I only listened to the positive message and I ignore the negative and I'm not really learning from it.
And so it actually creates some confusion about what needs improvement.
So the aha moment comes now. What I learned from her podcast was that you're supposed to critique instead of insult.
And honestly I didn't realize I was insulting people when I was telling them what they were doing wrong. But what I was doing is telling what they were doing wrong instead of focusing on comparing the performance to the ideal or critiquing them, which gives them some education is very specific and it gives them something to improve on. And it's that simple.
I seriously can't believe I never understood this. And even more ironic to me is that I've asked for feedback millions of times in my career.
I really wanted people to tell me how to do things better. And in the end, I almost never got that kind of feedback. Almost never did I feel like there was something actionable or useful. Everybody kept telling me the good things I was doing to reinforce them.
That's great. But nobody helped me figure out the things I wasn't doing well, like critiquing, which I could have gotten better at.
Now, an example of bad feedback might be something like you didn't do a good job doing that HPI during the clinic visit, or a slightly better version might be you need to do a better job documenting pain in the HPI.
But a really good example of how to help somebody is when interviewing the patient about pain, be sure to include a description using their words that might include the character like sharp or dull, the severity, the location, onset and exacerbating and relieving factors.
And if that's a lot, here's a handout or a reference to go to so you can remember it for next time.
Now, unfortunately I could tell you, I've given a lot of feedback that sounds like that first bad example, telling somebody what they didn't do a great job with.
If you're listening to this or if you're reading my blog and I did this to you, I am seriously sorry.
Now on the plus side, I feel like I have a much better way of helping people get where they need to go or where I think they need to go. And I also think this might be the key to better parenting or even improving feedback in my relationship.
And luckily, my partner only listens to murder podcasts, so she will be none the wiser.
But seriously, there are some really great basic concepts that I want to go through that help giving feedback even easier.
The first is to be direct about areas that need improvement without unnecessary sugarcoating so that people can focus on the behavior and the solution should also clearly state the observed behavior outcome that requires attention.
General feedback does not allow people to understand it or to change. If you want and can explain the impact of the behavior outcome on patient care or team dynamics or personal growth, so they have context and they can remember your feedback better as stories give powerful memories. Give the feedback comparing the observed behavior to the ideal and what would make it better.
This really allows them to focus on future behavior and keeps them on track and then frame the feedback in terms of specific actions that they can take. Examples are definitely useful. Avoid generalizations or comments about personality traits.
And this seems obvious, but it's really easy to fall into them. So instead of saying something like your perfectionism is slowing down the team, that doesn't provide anything actionable or give them tools. You might help them figure out what they could be doing that would be more useful next time.
So, hey, maybe we don't need to make sure every detail is right, but let's focus on the most important ones. What do you think those are?
Another example might be somebody who tells you that you're disorganized instead of talking about something you can do to address your organizational skills.
Now separating positive feedback from criticism is also really useful because you do want to reinforce positive traits or actions or behaviors.
And if you put them together with things that need attention, you're not always going to give the right message. And it's also useful to provide resources or suggest strategies for improvement when useful. Now, luckily in medicine, this is pretty easy to do.
The other two main points that Ms. Hermosi talked about was to give real time feedback. And the reason she talked about it is that recency allows the behavior to be fresh in someone's mind. So it's easier to understand and reflect upon.
It also gives them context. So it's a more nuanced conversation. It also reinforces positive behaviors immediately and increases the likelihood to repeat them while addressing negative behaviors quickly before they become habits.
Now in academic medicine, this might be giving brief feedback immediately before rounds or a procedure. It might be a quick debriefing session after a critical incident so you can change some interactions. And it's also useful to implant a system for real time peer feedback during collaborative work.
Now, if you're in the operating room or in the clinic, sometimes this is as easy as saying, let's just debrief that last patient.
She also talks about her third point, which is future focused feedback. And that's really to orient your feedback towards their future improvement instead of dwelling on anything they might've done in the past.
This actually helps align with a growth mindset and motivates positive change. And it's effective because it's constructive and actionable. It gives them clear direction.
It's motivating because it's encouraging about potential and progress, and it can reduce defensiveness by not dwelling on past errors.
Now examples here might be saying, instead of you misdiagnose the patient, you could say in future cases like this, consider these additional diagnostic criteria. Or instead of saying your presentation was disorganized, try for your next presentation, let's work on a structure that highlights key points more effectively or just effectively.
And then you can also replace things like you've been late to rounds three times this week with moving forward. What strategies can we implement to ensure you arrive on time?
If you want to put all this together, some actionable steps are to give immediate acknowledgement of good behavior, especially. Schedule a follow-up if you need more in-depth discussion.
Have future oriented discussions whenever possible. And have collaborative planning. Ask people what they can do or strategies that they can come up with so the positive behavior gets reinforced in the future.
Also give ongoing support, whether this is mentorship or resources or check-ins.
And examples of this might again be a doctor talking about a difficult patient interaction saying, I noticed some challenges in that conversation. Let's talk about it.
And during that debrief saying, how might we approach similar situations to ensure the patient feels heard while conveying critical information efficiently? We could brainstorm some communication strategies you could try next time.
By combining real-time feedback with positive intent and future focused approach, it's really important to create the environment that promotes continuous improvement and growth.
And by giving people feedback that talks about their actions or behavior against the ideal, instead of focusing on negative interactions in the past, you also focus long-term skill development and help them receive the input they need at the time they need it.
So in summary, effective feedback compares the behavior or outcome to the ideal and includes specific steps or information to do a better job next time.
And it's given as soon as possible after the behavior or outcome, ideally in real time.
And lastly, it focuses on future behavior.
Thank you for joining me this week on the podcast. I look forward to talking to you next week.
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