October 2021

Members & Publications

Constructive Criticism and Self-Advocacy During Training

Dr. Julie Witkowski


Julie Witkowski, MD
PGY5, Mayo Clinic College of Medicine and Science (Rochester) Brain Injury Fellowship

Feedback - at some point during their medical training or career nearly every physician will have both received feedback on their performance and be asked to give feedback to another individual. Regardless of whether we are on the giving or receiving end, most people feel some measure of anxiety or awkwardness when it comes to the feedback process. This process can be even more challenging when making the change from perpetual student to the role of clinician educator.

During the medical school and residency application process, it felt as though every ounce of feedback carried the weight of the world. This was particularly true when it came to formally documented feedback and evaluations. Students hope that glowing rotation evaluations will turn into stellar letters of recommendation, and that this culmination of compliments will materialize into the form of a satisfying residency match. When I entered into my residency training, I was so focused on trying to be as impressive as possible to my new colleagues that I remember taking even the smallest amount of constructive criticism as a sign that I wasn't performing up-to-par. This "must always be perfect" culture of medical training can be exhausting, and it can be difficult to shake when embarking on the most important part of the journey - becoming a great physician who is prepared for independent practice.

When formal mid-rotation feedback sessions were implemented at my training program, I found this to be incredibly helpful. I used these sessions as a spot-check to see what I was doing well and what I could improve upon, and then had the chance to implement these changes for the remainder of the rotation. Having these formally structured sessions lightened some of the pressure associated with feedback, as this became a routine and expected part of our departmental culture. That being said, with the huge variety in educational structures throughout the country, this is unfortunately not always feasible at every institution or in every setting.

Thus, at some point during my training I made the decision to self-advocate for opportunities for improvement. About halfway through residency training I began frankly asking for feedback from my senior resident or attending physician on a regular basis - at least weekly, if not daily. I decided to rip off the metaphorical Band-Aid, and regularly asked, "is there any feedback you think would be helpful for me to know, such as something I could have done better/differently, more/less of, etc.?" I also gradually learned to speak up more often when I had an opinion on something, discuss why and learn from the response. In doing so, I grew so much more as a physician, trainee and person.

You may be thinking: "What if I am working with an attending for only one day? What if I might be bothering them by asking for feedback on this particularly busy day in clinic?" In my experience, taking two to three minutes for discussion is not going to have a substantial impact on the day's busyness factor, and you probably don't want to miss an opportunity to hear the perspective of someone you had only one day to work with! Just remember, you are there to learn!

After my own personal experiences in residency, transitioning into more of a leadership role during fellowship, serving on many Graduate Medical Education committees and completing formal training on the feedback process, there is a pervasive theme that stands out regarding feedback: everyone seems to get the most out of it when it is given regularly, non-confrontationally, as promptly/on-the-spot as feasible and with areas for improvement being the main focus. Therefore, I encourage my colleagues to never stop self-advocating for these areas of improvement, and in-turn use their own experiences to provide constructive feedback to others when it is their turn to deliver.

One of the best feedback moments I can recall came toward the end of my fellowship year when I was doing an elective rotation in another inpatient department. The preceptor began by saying something that still sticks with me today, along the lines of the following: "In my experience, giving trainees genuinely constructive feedback can be what sets them apart. If I just continue to praise a trainee for all the things they are already doing well, they will probably leave the conversation feeling wonderful, but will not have had an opportunity to grow. Thus, I am going to focus the short time we have on talking about ways to fine-tune your skills as a physician. It is in this way that I believe young physicians learn to stay forever teachable and have the opportunity to become great."