Turning it around

Feedback isn't always straightforward.
[A Turn in the Road via wikimedia]

I certainly enjoy a good SP encounter. I love discovering how effective behaviours manifest and how they affect me so I can incorporate them into future feedback.

But one of my very favorite things is when a poor encounter becomes an excellent feedback session. This is only possible in places that allow the SP to have a genuine conversation with the learner, rather than using a specific format or a written form. But when it works it makes both of us leave the encounter feeling better. I see how the learners' posture & expressions change and they leave knowing how to make it right, feeling hopeful instead of defeated.

For instance (this is a living list. Last updated May 23, 2017):

• When the learner returned for feedback, he immediately admitted it had been a terrible encounter. Together we analyzed why, then I guided him through creating a specific plan to enhance those skills before the next event.

• During feedback during a poor encounter a learner admitted he had just been going through the motions during lung auscultation, but when he realized it he forced himself to do the exam again paying closer attention. It didn't affect the findings or anything else about the encounter, but I was so impressed I praised him for his self-awareness and integrity. Even if he got nothing else out of that encounter, I felt that was worth the whole thing.

• I could tell the feedback for this unsatisfying encounter wasn't landing for the learner until I stepped laterally and asked her why/how she had gotten into this particularly specialized program. Hearing her answer allowed me to target my feedback to meet her needs and her entire attitude became engaged and curious.

• "Oh, I should ask more questions!" the learner suddenly exclaimed during feedback after a particularly confusing encounter. I wanted to hug him.

• How I learned to begin each encounter with student self-reflection.

• Once a learner who had an awkward encounter came back to feedback crying. I didn't even try to give her feedback: I got her tissues, a drink of water, and asked her what was going on in her life. We talked a bit about how to compartmentalize emotions and release them between patients so she would be ready to do the next OSCE encounter in the rotation.

• We had had a lackluster encounter: even though he was using the right words, I had considered the learner scripted and demanding. So I used the Feedback Hierarchy to talk to him about posture, tone, facial expressions and word choices to convey sincerity. During feedback he became much more animated and engaged. As he left he shook my hand: "Thank you! That was was the best feedback I have ever had. That's exactly what I've been looking for."

• After a difficult encounter with a resistant client, I asked the group what questions they had. Nobody said anything for a long moment, then one woman spoke up: "Why were you so mean?" she asked, only half joking. Everyone laughed nervously, and I was tempted to laugh it off, too. But instead, I said, “Great question! Why was I so mean? Let’s ask the group! What are some reasons why people might be mean in a situation like this?” The group talked about a lot of factors that make people uncooperative: hunger, illness, power/age differentials, independence, control, comprehension. The tone immediately flipped from rejection to empathy & inquiry, which persisted throughout the debriefing. I am certain they will feel more kindly towards this kind of client in the future.

• He was clipped, curt and offered me no empathy for my symptoms. I had a feeling I wasn't the only SP who had worked with him who felt this way, so after the traditional "How did that go for you?" I asked, "What patient interaction skills are you working on? What's something another SP has mentioned that you are trying to incorporate into patient encounters?" When he told me what it was, I was able to validate I had seen him try that and we were able to discuss how to communicate that skill more effectively. That gave me a chance to talk about what I had noticed and he was able to reflect back to me that he really heard it and how he could imagine how small it made me feel. By the end, he was telling me about why he had gotten into medicine, and my eyes were shining with compassion.

• Right from the very start, the learner constantly interrupted me. She would start with an open-ended question but then immediately close it or cut me off or finish my answer before I could even open my mouth! In feedback, when I asked her how it had gone, she said fine, but she felt like she didn't connect with me very well. What was the earliest moment she remembered not being able to connect with me? I asked. "Kind of right from the start," she said. I agreed with her and we walked through how she immediately closed her opening question, and then we examined several instances of other interruptions -- even during the feedback! By the time we were finished, she was astonished. "It's true! I do interrupt people! How could I not know this? I've done a lot of these simulations and nobody has ever told me that before!" She was almost elated at discovering this aspect about herself.