Feedback is My Friend

A colleague sent me the following abstract that will appear in the May 2005 issue of Medical Education.

Sargeant J, Mann K, Ferrier S. Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness. Med Educ 2005; 39(5):497-504.
Purpose: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback.

Methods: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. Results Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback.

Conclusion: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlights questions for further study.
PubMed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15842684

I think this is a fascinating study that points to a critical flaw many of us physicians have - a big blind spot in the area of self-awareness.

One of the hallmarks of extraordinary performers is that they learn at an accelerated rate.   See Peak Performers and the Vertical Learning Curve. 

Professional athletes have long known this secret - the fastest way to learn is to use a coach whose job it is to provide them with multiple, objective data points (feedback). This outside perspective helps them recalibrate rapidly until they hit that stroke, do the dive, complete the triple axle or put the ball in the hole with the greatest accuracy and least amount of effort.  Without that outside perspective, they must depend on trial and error - not a very effective way to learn.

So what's the problem?  Why is it that physicians are so reluctant to seek out and hear feedback?  In my opinion our medical training is at least partly to blame.  Here are a few ideas:

1. As medical students and residents, we exist in a highly competitive rather than a collaborative environment.  Our would-be "coach" colleagues are vyying for that top class rank or that same choice residency slot as we are.
2. We're so used to getting feedback in the form of humiliation through the all too common practice of "pimping" that once we're out of training, heck if we'd ever subject ourselves willingly to the possibility of still more.
3. Medical school, residency and medical practice tend to be isolating for the individual.  We don't learn how to develop those trusted relationships with colleagues we can turn to for an honest, objective assessment.  And once we're out in practice, we often work solo, so there's not even anyone around.

Both giving and recieving feedback are acts of vulnerability and as a rule, I hate feeling vulnerable.

When I give feedback, I'm showing you my smallness (my pettiness), taking the risk that you will reject me, or possibly even retaliate.

When I'm receiving feedback, I may be hearing something that is very different from the image I hold of myself and I may not want to consider the fact that others may have a negative judgment of me.

What I've learned is that's really all it is - mine or another person's judgment.  Our judgments are not inherently right or wrong, they're just our opinions. 

Feedback is nothing more than information - really valuable information about how others perceive me.  Once given, I can choose to ignore it, or I may consider it to determine whether there's a grain or an entire wheat field of truth in it.  From there, I am in a position to recalibrate and course correct as necessary.

Without feedback, I'm basically working in the dark.  I have a blind spot and that's not an effective way for me to improve.  Einstein once said, "Insanity is doing the same thing over and over but expecting different results."

Over the years I've developed a network of people I know and trust to give me those objective data points.  I also find that working with a coach can be even more effective, especially when I'm not getting the results I expect.  A coach's main job is to give objective feedback designed to help me get results.  These are the people I rely on to give me the feedback I need. 

So when I'm hearing a piece of feedback that's hitting home in a painful way - I take a deep breath and remind myself that Feedback is My Friend!

Comments

[Medical Billing]

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