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- Dealing effectively...
- Dealing effectively with critical feedback as a doctor
Careers BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3758 (Published 19 June 2013) Cite this as: BMJ 2013;346:f3758
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- Joseph George, foundation year 2 doctor, plastic surgery1,
- Beryl De Souza, honorary clinical lecturer in plastic surgery2
- 1Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
- 2Imperial College London, UK
- bds{at}dr.com
Abstract
Doctors are increasingly required to provide feedback on colleagues and to accept criticism from their peers. Joseph George and Beryl De Souza look at how doctors can deal effectively with critical feedback
The introduction of revalidation has meant that providing feedback has become an important issue for all doctors. Feedback is intended to give doctors information about their practice through the eyes of those they work with. Doctors may be approached by peers or juniors to give feedback or they may be asking others to give feedback on their own performance.
Across the many recommendations of the Francis Report there was an emphasis on openness, transparency, candour, and accountability.1 This focus highlighted the importance of feedback and the need for NHS employers and medical royal colleges to provide more training in this area.
Medicine has always relied partly on apprentice-style mentoring to train doctors in the workplace, from junior doctor to consultant. This has now evolved into a structured system of work based assessments, recognising technical proficiency and skills in communication, clinical knowledge, and professionalism. The system also includes formal feedback for trainees through clinical evaluation exercises, case based discussions, direct observation of procedural skills, and multi-source feedback.
Informal feedback
Most feedback, however, is provided informally on a day to day basis, and is given on any aspect of a trainee’s performance and conduct, by any member of the multidisciplinary team. Such informal feedback may cause problems, though, because poorly framed feedback can have a deleterious effect on confidence, motivation, and subsequent reception of feedback. At the same time, trainees’ inexperience means they are more prone to making mistakes and as a result they are frequently exposed to negative feedback and personal criticism.
The General Medical Council’s Good Medical Practice emphasises that doctors should be honest and objective and that the way feedback is delivered influences its effectiveness.2 The Scottish Council for Postgraduate Medical and Dental Education has a set of strategies for giving effective feedback in any setting,3 and it recommends that effective feedback should be relevant, specific, timely, given privately, and based on behaviours not personalities (see box 1).
Box 1: Giving effective feedback
When giving effective feedback in any setting, it should be:
Based on behaviour, rather than focusing on personality. Reinforce positive aspects
Given privately—Avoid giving negative feedback in front of colleagues or patients
Relevant to the needs of the trainee (for example, training programme outcomes), and what is expected of his or her performance (for example, professional development)
Specific—Avoid vague generalised statements
Timely—Soon after the event
When providing feedback in difficult circ*mstances:
Avoid being judgmental, or assuming motives
Encourage trainees to reflect on the event and suggest improvements themselves. If they are unable to do this, you should describe what went wrong and suggest alternative behaviour
Focus on the positive aspects
Ensure the trainee agrees with the feedback and admits responsibility for part of the problem. If the trainee does not admit responsibility for the problem, explore why this is
Negotiate a solution and ensure that opportunities for remediation are available
Coping with critical feedback
When discussing negative feedback trainees and trainers may become defensive, but it is helpful to establish that the goal is providing the best care for the patient. The trainer or colleague may resort to a defensive mechanism on sensing a negative response from the respondent, and may then also fudge feedback with irrelevancies or seek to minimise the consequences of incorrect behaviour, even though both these behaviours bury the learning point and distract from the purpose of the feedback. These problems can be avoided by employing a range of strategies for providing feedback in difficult situations (box 1).
Trainees or colleagues sometimes blame others, deny the problem, rationalise their poor behaviour, or become angry. The London Deanery has developed guidance on giving feedback using an objective perspective.4 Coupling this guidance with a systematic approach to accepting feedback would help create a productive way of receiving constructive, negative feedback (box 2).
Box 2: How to receive constructive, negative feedback
Pause, listen, and think, rather than preparing your defence
Clarify, and ask for examples
Accept it positively, rather than dismissively, for consideration
Consider and use elements that are constructive
Ask for ways to modify your behaviour
Respect and thank the person giving feedback
In the current medical climate of litigation, and the perceived notion of zero tolerance to mistakes within the profession, doctors feel the need to protect themselves and dismiss criticism, but it must be remembered that the primary goal is the wellbeing of the patient.
A real change from a blame culture to a culture of constructive criticism, and support for colleagues and trainees to learn from mistakes and poor practice, is vital to improve patient care and services.
Footnotes
Competing interests: JG has no conflict of interest; BDS is a tutor on the Training the Trainers of Tomorrow programme in the London Deanery.
References
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The Francis Report. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013. www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf.
- ↵
General Medical Council. Good medical practice. GMC, 2013.
- ↵
Hesketh EA, Laidlaw JM. Developing the teaching instinct. Med Teacher2002;24:245-8.
OpenUrlCrossRef
- ↵
London Deanery. How to give feedback. 2012. http://faculty.londondeanery.ac.uk/e-learning/feedback.
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