I hear from students, residents, and surgeons alike that the feedback they receive from peers or supervisors is poorly delivered, emotionally charged, vague, or generally unhelpful; research suggests they’re right [1, 2]. Orthopaedic surgeons generally are not trained on how to offer feedback in a constructive way, but this can be taught and learned.
Don’t Rely on the “Compliment Sandwich”
Placing a criticism between two positive comments is a common approach to providing negative feedback known as the “compliment sandwich.” This approach is part of the business lexicon and is easily recognizable by the recipient as lacking sincerity [1, 2]. Instead of trying to fold a negative comment into this sandwich, utilize independent opportunities to give genuinely positive feedback for a job well-done. By doing so, you will be more likely to gain the trust of the recipient and when you need to offer that person a critique, the recipient will know it is coming from an honest place and (s)he will be more receptive to your direct suggestions.
The compliment sandwich can also confuse the recipient. Example: “I like how you used graphics in your presentation, but you talked too much on each slide and you ran over your allocated time. I did think that the content was appropriate for the audience, though.” By not being direct with a critique or offering ways to improve upon the negative aspects of the presentation, the individual may only take away the positive aspects of your message. Conversely, the recipient may recognize the compliment sandwich, dismiss your positive feedback as disingenuous, and believe that you thought (s)he gave a poor presentation. Instead, the discussion could be rephrased: “The content of your presentation was appropriate for the audience, and you made good use of graphics to convey key points. I think your presentation would be more effective if you remove the redundant examples and allow sufficient time for the audience to ask clarifying questions at the end.”
Context Matters: Give Specific and Actionable Feedback
Being clear and direct with your criticism is important, but providing negative feedback requires some nuance. Telling a colleague, “You’re not a team player” may convey a message directly, but this statement is vague, not actionable, and probably will evoke an emotional response, which can lead to an argument or even end the conversation [1, 2]. Think of specific examples to provide context to the recipient, such as, “I think the faculty would like to provide input on how to grow our referrals from primary care providers. When decisions are made without input from us, it’s hard to feel like part of the team.” The latter statement conveys the same message but provides context for how one’s actions can impact others.
Clarity is equally important when giving positive feedback. “Great job in the OR” may make a resident feel good about his or her performance, but it does not delineate specifically what was done well. Instead, celebrating specific behaviors such as, “I like how you outlined a preoperative plan and reviewed it with the staff prior to the patient entering the room” will let the resident know specifically what to continue doing.
Teachable Moments Can Occur at Any Time
While most of us can show our residents how we perform a certain surgical technique, the teachable moments do not end when the patient is out of the OR. I debrief with the residents, asking them what went well, what they learned, and what they would do differently. This conversation gives my residents an opportunity to reflect critically on their performance, identifying specific parts of surgery where they struggled, and how to improve for the next time. I then go through my list of what went well and outline specific actions I would like to see in the future. By having these conversations after each surgery, trainees are constantly receiving feedback and can adapt throughout the rotation instead of only receiving a midpoint or end-of-rotation evaluation where they may not have the opportunity to change behavior.
Some of our most memorable teaching moments occur from our mistakes. With trainees, we must assess each situation and each resident to tailor an appropriate amount of struggling with efficiency and patient safety. Some corrections cannot wait until the end of the case and must be done at the time of the error. As educators we need to be aware of the different ways in which people learn and adapt our teaching style to our learners as well as the ways in which we provide feedback.
Footnotes
A note from the Editor-in-Chief: We are pleased to present the next installment of “Pearls”, a column in Clinical Orthopaedics and Related Research®. In this column, distinguished surgeons, scientists, or scholars share surgical or professional tips they use to help surmount important or interesting problems. We welcome reader feedback on all our columns and articles; please send your comments to eic@clinorthop.org.
The author certifies that neither she, nor any members of her immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.
References
- 1.Cannon MD, Witherspoon R. Actionable feedback: Unlocking the power of learning and performance improvement. Academy of Management Executive. 2005;19:120-134. [Google Scholar]
- 2.Moss SE, Sanchez JI. Are your employees avoiding you? Managerial strategies for closing the feedback gap. Academy of Management Executive. 2004;18:32-44. [Google Scholar]