Criticism and Praise are Just Feedback

FeedbackIf you do or create anything unique, someone will critique it. Importantly, the emphasis here is on “it” – not “you,” even though the comments may be presented as if that person is critiquing you and not your idea, act, research, dress, or product. Many times these critiques seem to be personal attacks. Therefore, it is important to remember that acting upon ideas from within requires a thick skin and persevering in spite of criticism. This is also true in learning. Taking a chance at offering a solution to a problem and justifying your thought processes may end in feedback that sounds like criticism of your intellect, study habits, conscientiousness, professionalism, or readiness as a student doctor. This “criticism” is really just feedback that you need to make adjustments and go in a different direction.

To properly hear feedback and learn from it, a student will benefit from knowing how to step back and become an unemotional observer and analyze what CONTENT the faculty or attending is critiquing rather than what personal attack the faculty is making. If you present a novel solution to a problem in class and it is questioned, that may be scary, but it is not you that is being questioned, but the solution. Know also that in a true academic environment this endeavor would be encouraged because this is how new techniques get developed. There are also several different paths to the same solution and your path may be more efficient than others have thought through. If others challenge it, it is not you they are challenging, it is the idea, the thought pattern. Even if the challengers believe they are critiquing you, you can know where the critique actually lies. Your ‘self’ is still solid and crystallized.

If faculty say you have “been lazy and need to read more about your patients” – then stay objective and analyze the feedback. Rethink the “have been lazy” phrase. What it means is that your knowledge level is lacking and appears that you are not deficient in ability but in specific setting knowledge – hence not putting in the work needed. Take a step back… Listen to the message… It is feedback that you should perhaps listen to and respond to? Do I need to come in 30 minutes earlier each morning and read x, y, and z on each patient before rounds? Do I need to determine what in the new diagnosis seems to interest faculty and read up on it before going home from work? Analyze and motivate yourself to correct the ACT or BEHAVIOR – not yourself. Your ‘self’ is just fine.

What will you gain by becoming angry or hurt? Spending this time overanalyzing how your attending got to his/her conclusion only wastes time. I myself have done this and wasted a lot of time spinning out of control and preoccupied in my thoughts or telling my horror story over and over until I am exhausted. Even though you are a young professional, know that this is a hallmark of immaturity and that the sign of an adult professional is the ability to take the information and do something positive with it. Don’t obsess over it, just file it efficiently and immediately begin to work on it. The key is not to dwell, just work on solving it.

In the workplace you will often hear supervisors say, “I’m just giving you feedback about your performance, don’t take it personally.” Or following a performance evaluation, “I don’t understand why she is upset, this is doesn’t mean I don’t like her, it is just about her work.” Employees often have a difficult time separating out negative feedback from an attack on the person, where supervisors have are able to separate the two. The supervisor has learned to have the thicker skin and how to divide out performance feedback from personal feelings. A supervisor can like an employee and find them to be very caring, warm and personable, but not organized or efficient. If the supervisor gives this employee feedback that they would like to see them work on being more organized, this does not mean that there is something “wrong” with the employee or that her work is not highly valued. If the employee becomes focused on this one criticism, then she will not be able to move forward and improve as an employee. If the employee hears only the criticism or only the praise and becomes mired in the emotion rather than the facts of the feedback, she will not be able to adequately improve upon her performance.

Let’s take a minute to look at who is most vulnerable to becoming emotionally involved with critical feedback. If you are a person who hangs on to every compliment and remembers every word of praise, you will most likely take every message of feedback that says you are not perfect as a criticism of your person or self. If you value praise highly, it usually makes you equally vulnerable to criticism. Even though this person may deny any praise that comes their way, they still highly value the tribute to their character and skill and it is important to their self-esteem. This emotional high from praise will be short-lived because there is always room for improvement and it is the job of faculty to find ways for students to improve their performance; hence critical feedback. The student who thrives and improves is the student who handles praise and criticism equally, as feedback from which to learn. Keep including the actions that yield praise and improve upon the actions that yield critical feedback and move on. Those students who claim to have only received praise may fall in this category because they see their critical feedback as only that – just things to improve and thus not reportable. They focus and report to others only the positive. However, be warned that there are those that only hear praise and block out the negative, and they too will have difficulty moving forward improving their performance.

Faculty can be brutal and say things that sound like they are frustrated or angry with you. They may be. They are stressed, overworked, and have trained hundreds of students over the years. If you take what they say as a personal affront, then you will not be able to perform. You will become emotionally involved and frozen in being self-absorbed rather than motivated to solve a problem. When you break it down and take out all the gooey, messy emotion, all this is… is feedback. It has come in a different form than what you are used to. It is not in the form of an exam with a grade, nor a formal session with a rating scale of sets of your skills. It is feedback that has been verbalized in the heat of the moment, when the faculty member is feeling stressed by time and the need to improve the performance of everyone on her team. Take it as that. If you are not clear on what your assignment should be to improve your performance, talk to the resident or faculty member and ask them to help better define a plan to improve your performance in that area. In the vast majority of cases, they will greatly respect that you did not take the feedback personally, but are taking action to improve performance.

What makes medical students today believe that physicians should today be kind, considerate, and tender in training students on the floor? Is it not similar to being in boot camp, getting a soldier ready to go out to battle? If the training officer is not in the soldier’s face pushing them night and day to be their most alert, in prime physical condition, and working as a streamlined team, they will not survive after training. That is their job, to take a simulated environment and create the stress that a soldier will experience on the field and make them think under stressful circumstances over and over again until they can do it skillfully and expertly. This is how they will survive.

However, before you stop reading, know that there are many arguments and stories out there where faculty go way beyond firing questions at you after you have worked on your feet for 10 hours, and stress you by insulting you in front of your peers, so maybe you can handle the stress of making quick decisions about critical patients in multiple emergency situations throughout the day without making mistakes. You can hear and read about abuses that go way beyond training that moves over to abuse and harassment. This can be hugely distracting and are unprofessional and a hindrance to learning. Students are often reluctant to report these incidences or faculty that repeatedly abuse their positions of power out of fear of retribution and the possible impact on their grade, letters of recommendation, or comments in their MSPE letters.

There are multiple ways to cope with these situations. One is to find an anonymous method of reporting the abuse. Many health institutions are aware of the need for anonymous complaints against faculty and have anonymous means of reporting professionalism concerns. The other is to give yourself a limited amount of time to be angry, do not discuss your anger with colleagues as your comments will often be overheard or be used against you, and again do not take it personally. Use what you can to improve your performance and throw the rest out with the bathwater. Do not let this affect your self-esteem. What is really going on here is a faculty member with stress problems, professionalism issues, communication troubles, and problems with aggression. Put it in its proper place… this is not your problem, but his or her problem. If you find yourself the target of the majority of the aggression, then record the instances and calmly and objectively (not emotionally) report your observations to a faculty mentor and ask for advice on how to handle the situation. Go to the Dean of Clinical Education or Dean that handles professionalism and ask for advice.

Most importantly, you can’t take this personally and worry about your ego until it blocks your performance. When you receive appropriate feedback from a faculty attending, it is only feedback that your knowledge base, skill set in an area, or response speed needs some work. Even if they are hard on you but appropriate in their feedback, take it as someone who cares about your performance. Thank them for caring so much about teaching you and about caring about wanting the best care for patients. Aren’t they real heroes for pushing you so hard to make you the best physician you can be? Would Winnie the Pooh really make you the best doctor you can be or will it be the tough task master that makes you do it again and again and again? When it comes down to being the best doctor you can be would you rather be coddled or challenged? If you only heard praise would you learn to correct your weak areas and improve to be a well-rounded physician?

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