John Price, M4, Class of 2020
Self-improvement starts with a question, albeit a simple one:
“What am I doing that is right, and what am I doing that is wrong?”
Rarely are we self-aware enough to be able to answer that question ourselves; we often rely upon others to point us in the right direction. Attendings, residents, nurses, classmates, and other healthcare workers often provide those nudges. This feedback usually takes the form of you being told outright what you did wrong or right. Often, that is the end of the conversation. There is no proper or considerate explanation of how to avoid or achieve a different specified outcome in the future.
Imagine it is Monday morning. You meet your attending for the first time. You nervously begin your patient presentation, stuttering occasionally, with the sweat budding on your brow. Suddenly, the attending cuts you off midsentence; sharply saying “you are doing it wrong.” You understand that you made a mistake, but have no further direction as to what needs to change. Tuesday rolls around, and you begin your patient presentation in a very different way than Monday, slightly less nervous than before. Again, the attending cuts you off midsentence because you are, once again, “doing it wrong.” This pattern repeats till the end of the week, when the attending finally gets around to telling you what you are doing wrong.
This is a disaster for students who are eager to learn. Feedback should be constructive criticism – emphasis on the constructive. Constructive criticism is, to quote an online dictionary “a recommended set of instruction that aims to collaboratively improve the overall quality of a…service.” More plainly, a teacher informs the learner what was right/wrong, how to modify and work together to achieve better/different outcomes. So instead of the attending stopping you midsentence to say “you are doing it wrong”, what if the attending actually tells you how to do it right the next time? Wouldn’t this lead to a better, faster improvement?
Medical students need to be criticized in a constructive manner to be properly molded into lifelong learners, providers, and future instructors. Teachers should be telling you what is being done right, as well as what is being done wrong, and how to change for the better. It can be harsh to be corrected in front of your peers, fellow professionals, and teachers, but It is a good learning experience. Besides, we will all be wrong in front of our patient at some point in our lives – why not practice first in front of our peers? In the end, we will not be able to learn, practice, and achieve perfection without someone taking the time to notice our mistakes and determining solutions to avoid duplicating mistakes as future instructors.
As I have attempted to forge good habits through my third year of medical school, I have come to a realization: I can either wait or seek out constructive criticism. Waiting for the attendings and residents to provide makes sense on the surface. After all, students are paying the university quite a few bucks to learn. The physicians are required to provide feedback, and many rotations even require a mandatory review sessions. Sadly, though, if many receive the feedback of “doing fine” with a grade of 80%. It can be arduous to contact the teacher to determine what went wrong or how to improve the 20% that was lacking, as they might not even remember the details weeks later. As a surgeon, say you had 20% of your patients die and you were supervised for these operations. Wouldn’t you want to know what went wrong and how to avoid it next time?
What To Do About It
1) Quicker turnaround between student action and teacher criticism. The time lapse between my actions and my feedback was prohibitive to impactful constructive criticism. Learning well after the fact that I was doing something wrong was somewhat useful, but having the opportunity to adjust the course of care in the moment with my teacher would be a much more effective pathway to improvement. Ultimately, this would result in better healthcare being delivered.
2) Seek criticism yourself. Seeking criticism may identify a failure pattern and push yourself to grow daily, especially there be a limited number of teachers with limited time to critique you. If your attending and resident change every half-day, they will have less insight to your knowledge base and capabilities. Limit the number of people you ask everyday and ask teachers of different levels and disciplines for different perspectives. These different perspectives can provide valuable insight for improving your actions.
We are often told that changing the future begins with changing oneself. It is tough to change yourself; it is tough to change your habits. However, I firmly believe it is a worthwhile endeavor to grow and change as we advance forward in education and practice. I hope these thoughts and suggestions help to guide future medical students and colleagues to optimize their learning experiences, in the third year and beyond.