Friend or Foe? Embracing Feedback in Medical Training

The familiar buzz of my phone vibrating alerted me to a new email. The subject line read: "An evaluation has been submitted about you." Having just completed my first clinical rotation of medical school, I knew it was from my surgical clerkship. I quickly scanned the generic comments that everyone seems to receive—"team player," "hard working," "continue to read"—and lingered on one that caught me off guard. "She may be smart, but she was too quiet, and we had to drag answers out of her." I was upset that no one had mentioned anything about this during the rotation. In the same turn, at no point did I check in with my residents or attending to see how I was doing.

In a perfect world, those in training would independently seek out feedback from supervisors. Likewise, supervisors would carve out time for this purpose. The real world is messy. Sometimes patient care takes up more time than planned. Sometimes outside commitments eat away at precious free time. Sometimes feedback is dished out in small parcels that are easily missed.

Evaluations are built into the structure of training and can serve as more than just anxiety-provoking documents. Consider shifting your focus from the purpose these evaluations may serve for your medical school or training program to how they can serve you. The tips below can help you get more out of the evaluation process.

Set an intention at the start of a rotation for what you would like to learn, accomplish, and improve upon. Goal setting has been associated with greater success in clinical training (1, 2) and will give you something concrete to reference.

Make these goals known to your attending or residents. A systematic review and meta-analysis found that goal setting was particularly effective when the goal was set publicly and paired with external monitoring by others (3).

Check in throughout your rotation to get specific feedback. Thematic analysis of the quality of evaluations received by residents across a variety of medical specialties identified that feedback was insufficiently detailed, not paired with actionable plans, and not given in the moment (4).

When meeting for official mid-rotation or end-of-rotation feedback, be assertive in asking about others’ assessments of the intentions you set at the start of the rotation.

What if the feedback you receive is negative? Studies have demonstrated what many who are reading this have experienced: feeling rejected can cause a physical sensation of pain (5). In this state of being, it can be difficult to objectively process the information being provided. Although positive feedback may be easier to digest, negative feedback can provide what the cognitive model of learning defines as "information used to reduce discrepancies between a target goal and current state." When the negative feedback is informative (elaborative) instead of confirmatory (verification), subsequent performance has been shown to improve (6). Thus, if you are given a vague poor review, probe for specific information and suggestions about how your performance can improve.

For trainees, evaluations can have an impact on residency, fellowship, and even job placement. However, it is important to keep in mind that the goal of training is not simply to get through it. Learning, accessing resources, and mentoring are all important opportunities afforded those in training. By setting goals and leveraging feedback to accomplish them, learners grow as people and physicians.