4 Giving & Receiving Feedback

PART I – GIVING FEEDBACK

“No matter how good you think you are as a leader, my goodness, the people around you will have all kinds of ideas for how you can get better. So for me, the most fundamental thing about leadership is to have the humility to continue to get feedback and to try to get better – because your job is to try to help everybody else get better.”

– Jim Yong Kim

Why Do We Give Feedback?

Giving feedback to others is a necessary part of life and will be required of you in all roles, as a veterinary student, employer, employee, partner, friend, or parent.  Feedback will have an immeasurable impact on your professional experiences both short-term while in school as well as your long-term career success, but will also impact and influence your personal relationships.  Learning and practicing the art of feedback is a professional responsibility and benefits personal relationships, as well.  Ultimately, the underlying reason for providing feedback should be a desire for improvement; that is, feedback should be a means to help another person.

As a veterinary student, you will have multiple opportunities throughout your education to provide feedback.  Course and instructor evaluations, peer evaluation during your professional development courses, clinical rotation evaluations, and via your class representatives all offer opportunities to provide feedback.  Your feedback is always taken seriously, and the impacts are broad and tangible.  Providing feedback is a reflection of your investment in your own education, as well as the education of the veterinarians who will be trained with and after you.  In addition, providing feedback throughout vet school allows you to practice this valuable skill and, hopefully, form a habit, as you will need to be able to provide feedback in order to be an effective member of a veterinary health care team.

As a practicing veterinarian, you will be a leader within your team and can influence the culture of that team. Effective feedback can increase trust in relationships and improve team functioning, all of which affects the quality of patient care^[1].  Like any other skill, giving feedback can be practiced and honed.

When and Where Should We Give Feedback?

Although there is not a specific, prescriptive, one-size-fits-all answer to this question, spending some thinking about and preparing for the interaction is always warranted.  Key questions to consider when planning how to deliver feedback include:

• is the feedback I’m preparing to give informal to formal?
• to what degree of intensity is the subject of my feedback?
• what is the feedback culture of the organization?
• what is the state of the recipient?
• what is my personal resource tank level?
• would in-the-moment feedback be helpful or harmful in this situation?

Setting

In general, constructive criticism and negative feedback should be delivered in private.  Finding a quiet, neutral location free of interruptions to have the discussion is critical.  If the feedback recipient feels embarrassed or humiliated in front of others, they are far less likely to take in what you are saying.  Furthermore, only necessary people should be included in the conversation to protect the recipient’s privacy.

Timing

For feedback to be most effective, it needs to be timely.  Delivering feedback to someone 6 months after an event benefits neither them or you; if the recipient cannot remember the scenario, it will be difficult for them to imagine the desired change, and if enough time passes, you may have trouble remembering details that would make the feedback meaningful.  Whenever possible, give feedback as close to the actual action so that memories are fresh and change can be exacted quickly.

Your own emotional state

Before delivering feedback, ensure that you are acting from a place of positive intent and that you are in the appropriate mindset to deliver unbiased, respectful feedback.  If you are angry or having other negative feelings, that is not the time for the conversation with the recipient.  Although timely feedback is important, it is important to balance this with the need to ensure you have had time to reflect and process.  Leave emotions out of the feedback to the best of your ability.

How Should We Give Feedback?

In order for feedback to be useful, it has to be actionable, meaning that the receiver of the feedback comes away from the interaction with an idea of how to adjust their behavior, work, etc. in order to improve.  To yield results that are appropriate and tangible actionable feedback must be:

• Specific

Details matter when providing feedback.  Restrict feedback to things you know for sure and be descriptive, rather than abstract.  For example, “you don’t respect me” is a broad statement and provides no context for the receiver.  Instead, focus on a specific instance to better highlight the issue: “In yesterday’s staff meeting, you interrupted me as I was speaking about planning the staff retreat.”

•   Concrete

Telling a colleague that they are “never on time” is a vague generalization and may not lead to any tangible changes in the feedback recipient.  Instead, cite actual information, such as “I noticed that you’ve been late to the weekly staff for the last 3 weeks.”  Speaking for yourself and not others (e.g., “I feel” vs. “everyone feels”), and only discussing what you know as fact is critical. Additionally, issues should be phrased as “I” statements and not as questions to remove ambiguity.  For example, stating “I was unclear on how the idea fit with the task” is much more direct and clearer than asking “how did your idea fit with the task?”

• Realistic

Avoid hyperbole, exaggeration, and speculation when providing feedback.  If you’ll be offering a plan for change (see below), it will need to be attainable and manageable.  Thinking through the details of what you’re asking and envisioning how it could actually be put into practice in that setting is important before proposing changes.

• Respectful

As we will discuss later in the chapter, receiving feedback can be stressful, so striving to deliver feedback in a respectful and calm manner is critical in ensuring your message is heard.  There is never a place for profanity when giving feedback, especially when thinking back to the overall goal of helping another person improve and grow.

• Avoids bias, personal attacks or judgements 

Using “I” statements, rather than “you” statements, turns the focus from blaming or labeling to how the behavior or event impacted you.  Instead of saying “you were being passive aggressive”, try reframing the statement to something like “during yesterday’s meeting I interpreted your statement about the staff retreat as some lingering frustration. Is that correct?” Furthermore, it may be necessary to think about what biases you might be bringing to the conversation in advance to avoid clouding your intent when providing the feedback.  For example, if you had been raised that to be early is to be on time and to be on time is to be late, you may be less tolerant of those who arrive after a meeting begins than someone who was not raised with that same belief.

• Provides explanation for why a recommendation is made

If appropriate, you may be making a suggestion as to how to improve the situation moving forward.  If so, the rationale for the suggestion should be included.

Once we know what we would like to say, we have to consider the best how to deliver the feedback.  In her TED talk titled “The secret to giving great feedback”, LeeAnn Renninger describes a 4-part formula for how to structure your feedback for success:

1. Ask permission (also known as the “micro yes”)

In order for the receiver to effectively take in your feedback, they need to be in the right frame of mind and willing and able to listen to what you have to say.  Asking permission creates buy-in on the part of the receiver, as they are choosing to be open to your feedback.  This also gives the receiver a chance to say no – perhaps this is not the best time for them, or they are not prepared, at that moment, to take in feedback.  This is an important boundary, as delivering unwanted feedback at an inopportune time greatly decreases its effectiveness.

2. Describe the behavior

Use the principles of actionable feedback provided above to deliver specific, respectful, and unbiased information to the receiver.  Remove any emotion or judgment from your description.  For example, saying “you were being passive aggressive yesterday” is applying a label and a judgment to a behavior.  Instead, try saying “yesterday, you had your arms crossed, you rolled your eyes, and you were talking under your breath after I asked you to help clean up the surgery prep area.”  To craft impartial descriptions of behaviors or events, it may help to think of this step as describing what a video camera would have recorded in the moment; video cameras do not pick up on intention, feelings, or emotions, but instead document actions, words, and visuals.

3. Impact

This should be a description of what happened when the behavior occurred and should help the learner identify the role their action played in the scenario. For example, “when you were late to the staff meeting last week [behavior], we had to repeat what had been said about several topics before your arrival, which prevented us from covering all the items on the agenda [impact].”  Once again, it is important to only state the facts and leave out emotions, labels, and judgment, much as what a video camera would see.

4. Action/plan

Ideally this is an opportunity to collaborate on an action plan in which both parties identify changes they can make to create a different outcome the next time a similar situation arises. Inviting the feedback recipient into the conversation with a question is a very effective strategy to gain input in creating a solution that works for both you and the recipient.  For example, instead of mandating “from now on, you’ll need to start your appointments on time”, you might ask the recipient, “what ideas do you have for ensuring an on-time start for your appointments?”  This collaboration allows the recipient to have some autonomy over the changes and may lead to a better outcome.  Of course, in some instances it will be appropriate for you to propose a solution or plan; in these times it will be important to ensure the plan is realistic, specific, and achievable.

Positive Feedback and Praise

To this point, we have focused on constructive criticism.  However, you will undoubtedly be delivering positive feedback to many people in your life, as well.  When those around us do things well, we want to be able to reinforce that behavior so that it will continue to happen in the future.  All of the principles of actionable feedback and the format for delivering it apply, and your role is to help people hear and accept your compliments when giving positive feedback.  For example, when reading evaluations at the end of the semester, a comment such as “this course was awesome“, while nice to hear, doesn’t provide an instructor with any information about what to keep doing for future classes and what to change.  More specific, actionable feedback, such as “the necropsy lab was great – it allowed me to practice my skills in a small group and the handouts provided beforehand really prepared me“, tells the course instructor exactly what to keep doing.

PART II – RECEIVING FEEDBACK

“Criticism is inherently neither constructive nor destructive. It’s just information. If you use that criticism to bash yourself or undermine your self-esteem, it will be harmful. If you dismiss criticism out of hand – without examining it for the value – it will be useless. But if you assess criticism objectively and without emotion, you can discover what’s useful to you, and shrug the rest off.”

– Debra Russell

In all aspects of your life, it is important to remember that you are a human and, therefore, mistakes are inevitable, as is receiving feedback and constructive criticism.  In almost all cases, feedback is not meant to be hurtful or taken personally.  In fact, as discussed above, the intention behind one person giving feedback to another is usually to help someone be the best version of themselves. Although receiving feedback can be challenging, there is nearly always something to be learned or taken away from these critiques.  Despite the fact that mistakes are unavoidable, for many, receiving constructive criticism or negative feedback can be uncomfortable or stressful.  For some, even anticipating feedback can induce anxiety.  Although this discomfort does not go away with practice, it can be managed.  If you can remember that feedback is necessary for growth and is meant to help, these moments can be seen as opportunities.

Ali H. Algiraigri of the University of Calgary described 10 tips to help trainees in the medical field seek, receive, and handle feedback effectively to achieve “feedback literacy”^[2]:

1. Self-assessment

Humans are notoriously bad at introspection and self-evaluation.  For all of us, there are things about ourselves that we just can’t see and for which we need others to provide us with feedback.  Nevertheless, routinely taking stock of our strengths and weaknesses can help us to reduce the size of this “blind spot” and see ourselves more clearly.

2. We all benefit from feedback

Recognizing that it is human nature to have these blind-spots about ourselves means that anyone and everyone needs feedback.  Thus, it may help to alleviate some of the stress surrounding the feedback process when you consider that, no matter the station, accomplishments, or position a person holds, they can benefit from feedback.

3. Connect with your instructors, employers, etc.

Building connections with those who are in a position to provide you with feedback can lead to more frequent, useful, and meaningful evaluations of your performance.

4. Ask for feedback

Students in health professions unfailingly report that they do not receive enough feedback or critique during their education.  Just as with any skill, becoming proficient at receiving feedback requires practice.  Therefore, in veterinary school and beyond, you may have to actively seek out opportunities for assessment in order to get the practice you need.

5. Be confident and take positive feedback wisely

Just as one can become more skilled at receiving constructive feedback with practice, there is also an art to receiving positive feedback.  If someone has taken the time to provide you with feedback, it means they are invested in your success.  It is easy to ignore or downplay positive feedback, especially when it is given in combination with constructive comments, but we should resist brushing off or negating positive feedback as we risk failing to learn what it is we should keep doing to be successful.  Instead, we should thank the one offering the input, and identify the details that made you successful.  Just as for negative feedback, if you need more specific details about what worked well and what you should keep doing, ask the feedback provider to elaborate.

6. Control your emotions

As described above, receiving feedback can be stress-inducing.  Managing your feelings to prevent them from clouding your ability to hear the message is an essential skill.  When receiving negative feedback, take a deep breath and listen carefully.  Ask questions, if necessary, and stay calm so that you don’t miss any of the message. If not provided, ask for examples.  Fight the natural tendency to become defensive or brush off the message and acknowledge the truths that might be useful to help you improve your performance or results.  Conversely, not all feedback will be useful or relevant, so spend time reflecting on the information at a later time to decide which pieces of feedback to utilize and which to ignore.  Finally, although easier said than done, try not to dwell on any unhelpful or unkind statements; focus on what you can change and let go of the rest.

7. Take action with a plan

Feedback in and of itself is not useful unless you act upon the information you learn.  Think about how you can make changes to improve and create a plan for moving forward.  In some cases you will create an action plan with someone who has provided you with feedback.  In other instances, you will need to create your own plan.  Remember, that the best plans are SMART: Specific, Measurable, Achievable, Relevant, and Time-bound.

8. Acknowledge the generations

Generational differences in how people like to receive feedback do exist and may influence how those same people deliver feedback to others. For example, someone who has only ever received feedback once a year in a formal setting for their entire career may be unaccustomed to delivering more frequent, “lower stakes” check-ins that a feedback recipient might desire.  In these cases, having an open conversation about the feedback styles of the two people involved can help to resolve discrepancies and set mutually-agreed upon expectations.

9. Be specific and ask about general feedback

In order to make meaningful changes based on feedback you receive, you will need specific, detailed information about what went well and what can be improved.  Use your reflective listening skills, such as paraphrasing, to be sure you hear the message correctly.  Ask for examples when a piece of feedback is too vague or seems abstract and ask for clarification if you don’t understand something said during the conversation.

10. Be ready – feedback is not just one time and can be given at any time

Although you will experience many traditional performance reviews in veterinary school and your career in the form of tests, rotation evaluations, regular job evaluations, etc., it is also important to recognize that feedback can be delivered in a number of ways and at any time.  In veterinary school, we think of course evaluations for instructors and rotation evaluations for students completing a clinic block, but small things, such as a clinician stopping you during a case presentation to adjust the format of your delivery or suggesting a different way for holding your suture when performing hand-ties, are also pieces of feedback.  Certainly, the feedback culture of organizations varies, and we can quickly grow accustomed to the culture of the organizations in which we spend our time. Organizations that embrace frequent feedback at all levels create environments in which feedback is shared regularly between colleagues, inherently decreasing the ‘high stakes’ feelings that are attached to infrequent feedback.

Peer Feedback

Evaluative judgment is defined as the “capability to make decisions about the quality of work of self and others”^[3] and not just to make those judgements but to defend them, argue persuasively, listen to other arguments and consider whether a judgment needs to be modified^[4].  Evaluative judgment can be developed through self and peer assessment activities. This helps bridge the gap between what you, as a student, know and can do and what you are learning to be. Higher education does not offer many opportunities to see examples of peers’ work and this makes it difficult to get a sense of academic standards and benchmark your own work^[5].  Ajjawai et al.^[6] suggest five steps for developing informed judgment:

1. Identifying oneself as an active learner.
2. Identifying one’s level of knowledge and the gaps in this.
3. Practicing testing and judging.
4. Developing these skills over time.
5. Embodying reflexivity and commitment.

Molloy and Boud (2013) distinguish two types of feedback practices, one of which is teacher focused and one which is learner focused and they take on an active role by soliciting feedback, using it to develop their learning. In this way, feedback becomes part of their learning process, and they continue seeking feedback in their professional careers. The external or solicited feedback students seek from others helps build evaluative judgment skills about their own work. In the beginning phases of this process, learners also require guidance for feedback integration and application. ^[7] This really can be simplified by saying that actively seeking and evaluating feedback will create a growth mindset that will serve you personally and professionally as you navigate your future and the only way to develop this skill is to practice.

Composing feedback is more cognitively demanding than receiving feedback. When you articulate what you value in a peer’s work, you are articulating your understanding of academic standards. It is possible that you may learn more from the process of judging others’ work than from receiving feedback on your own work.^[8]

All of this said, giving and receiving peer feedback may feel uncomfortable, even painful for some in the moment, however it is invaluable in the trajectory of your professional growth.  Participation in feedback practice may require you to make a decision to leave your comfort zone and enter your challenge zone. Dweck reminds us that individuals who believe their talents can be developed (through hard work, good strategies, and input from others) have a growth mindset. They tend to achieve more than those with a more fixed mindset (those who believe their talents are innate gifts). This is because they worry less about looking smart and put more energy into learning.^[9]