This blog is the first in a new series that we are publishing on the soft skills that all premedical students should develop prior to starting medical school. While your academic preparation has been underway for many years, we don’t want you to forget about those skills we believe will be vital to your success in medical school (and beyond).
Many pre-medical students have spent the majority of their lives receiving praise and playing starring roles both inside and outside of the classroom. Your commitment to success is part of why you made it into medical school, but it can also make the transition particularly tough. Medical school is not only a challenging academic environment, it is a time filled with new experiences and, accordingly, a lot of mistakes. You will get critical feedback in large doses.
“My first piece of written feedback during my clinical year was ripe with criticism. I regrettably reacted to it by reading and re-reading it, allowing discouragement and imposter’s syndrome to slowly infiltrate my psyche. My voice began quivering during my presentations on rounds. My thoughts quickly became consumed with what every attending might be thinking of me at any given moment. It became harder to concentrate and learn. I stood in my own way, allowing my dependence on external validation to hamper my professional growth,” said Nabeel Salka, a third-year medical student at the University of Michigan, in a personal essay.
In preparation for medical school, we want you to gain some comfort with the discomfort. We urge you to practice requesting and receiving negative feedback because feedback plays a critical role in performance and leadership effectiveness. Dr. Sheila Heen, a lecturer at Harvard Law School and author of Thanks for the Feedback: The Science and Art of Receiving Feedback Well, regularly references research that says those who regularly seek critical feedback report higher job satisfaction, adapt better into new roles, and receive higher performance reviews than those who do not seek out feedback.
But it’s not always easy. Dr. Heen points out that feedback can cause various “trigger” responses, such as truth triggers, relationship triggers, and identity triggers that make it difficult to productively receive the provider’s message.
--Truth triggers: When we question the veracity of the feedback. We may feel misunderstood, wronged, or indignant, and we are more likely to reject the feedback or go on the defensive.
--Relationship triggers: When the person providing the feedback colors how we receive it. We may feel targeted or bullied.
--Identity triggers: When feedback hits at how we see ourselves. We may feel shaken, confused, and particularly sensitive.
So, once you identify your triggers, what’s the next step? Tasha Eurich, organizational psychologist and executive coach, provides guidelines for overcoming the initial emotional reaction, and accepting critical feedback for the useful tool that it is.
--Don’t rush it. Negative feedback is inherently uncomfortable and emotional. Sit with the discomfort, feel the emotions, and don’t feel compelled to respond to feedback immediately. While researching for her book, Insight, Eurich interviewed a group of people who dramatically improved in self-awareness. Within this group, two clear patterns emerged: First, she found that they made a habit of seeking out critical feedback (although many agreed it was “unpleasant”). Second, after receiving feedback, they took their time, days or even weeks, to respond. During this reflection period, some worked to transform their view of the feedback from an emotional reaction (e.g, “upsetting”) to a rational one (e.g, “helpful and productive data”). Others used “self-affirmation” techniques such as considering their many good qualities (“I am a committed medical student.'') to contextualize the feedback into a broader picture, thus making it feel less threatening.
--Gather more data. Request additional data points via feedback from others to understand the situation more completely. Is this feedback relevant to many interactions or is it an outlier? Find out if others agree and what additional context they can provide. In addition to providing a more complete picture and reducing personal blind spots, the additional data can help inform an improvement strategy.
--Don’t choose isolation. There is a real tendency for people to cut off relationships with those who provide negative feedback, to their own detriment. Eurich references research by Marshall Goldsmith and Howard Morgan, who tracked 11,000 leaders within a leadership development program; the contingent who received critical feedback and continued to engage with their coworkers made dramatic behavioral improvements, while those who didn’t were much less likely to see improvement. Maintaining relationships with those who provide difficult feedback drives better progression over time.
Within medicine, particularly in the clinical setting, there are additional barriers to feedback beyond our own emotional responses. An article in the NEJM Resident 360 identifies the following: not enough time, conflicting priorities, lack of physical/private space to provide feedback, power differentials (particularly for upward feedback), lack of (enough) observations, and a lack of a growth mindset (receiver). Understanding these barriers can help you to create structures to overcome them, such as seeking out feedback on a routine basis, learning to identify feedback in whatever form it may come, gaining comfort in hearing feedback publicly, and accepting that some feedback may not be valid due to a lack of observations.
Nabeel Salka ended his personal essay by describing the power he felt when he learned to accept negative feedback for what it is, a growth opportunity rather than an indictment of his abilities as a physician. He wrote, “Nearly a year after receiving my first piece of written feedback, I read it again. This time I didn’t feel hurt or ashamed. In fact, I felt like I understood the actual content of the criticism for the first time. Rather than concerning myself with the grade and how much the resident disapproved of my performance, I learned that I could be more organized when presenting.”
Starting medical school with an ability to see criticism as a learning moment, and nothing more, will allow you to enjoy and take advantage of challenging opportunities in this unique period of your life.
