“Your presentations were disorganized at times. And I expect students to be more independent at this point.”
Ok.
“You have some gaps in your knowledge. I want to encourage you to read more.”
Ok.
2/ “Also--I think you dress rather casual for the hospital. I wouldn’t want you to be perceived as unprofessional, you know?”
Swallow. Blink.
“Like, those shoes. Are they sneakers?”
Wait. Huh?
“Um. They’re just comfortable. I mean. . .no, they aren’t sneakers.”
“Well.”
3/ Well, what? I wanted to know. You expound.
“Well. You want to look the part. Like a doctor, you know? You want patients to feel like they can trust you when they see you.”
Swallow. Blink. Harder.
“Otherwise, I think you’ll do fine. Just keep reading.”
You smile.
Ok.
4/ After that, you shift to small talk. Like, what rotation are you on next? What state are you from? And, the best one, do you have a dog?
And me, I sat there. Just answering those questions like no big deal:
Surgery. Kentucky. Back home I do. A rescue.
You smile again.
5/ I’d worked with you for 2 full weeks. Okay, 12 days if you count when I had class. But still. That was a lot of time I thought.
You liked that small talk. One day you asked the team at the elevator if we liked cilantro. Another time we talked about Machu Picchu.
Yup.
6/ And all of that was cool, because it eased the learning climate. So maybe all that small talk made me think things were going fine, you know?
That and the one time you gave me a fist bump after my presentation on atrial fibrillation.👊🏾
That was nice.
7/ Beyond that, you gave me no real feedback. All I could do was try to decipher what you didn’t say. Look to see if your brow might furrow or rise as a clue. Otherwise, I got nothing.
Except the nice fist bump.👊🏾
I presented to you every day.
(And wore those same shoes, too.)
8/ You were still talking. Telling me of something that happened when you were a med student and asking how often I get home to Kentucky.
“Every few months.” I smiled. Though I just wanted you to wish me well and let me go.
Go to read.
Get organized.
Get new shoes.
Cry?
9/ My issue wasn’t the feedback. It was not.
It was that you saved it all up for a sucker punch on the last day. Offering me no chance to autocorrect or step up. Using all your breath on queries about who has the best Korean BBQ and how I felt about the new Lion King movie.
10/ Wait. I take that back. It was the feedback. And the timing, too.
I wonder: Did you want me to be better? To win?
I have two favorite Korean BBQ spots. And the talking animals in the new film were just weird.
I wish this other stuff you're saying could’ve come up, too.
11/ So what even counts as feedback? One (epic) throwback paper said this:
“an informed, nonevaluative, objective appraisal of performance intended to improve clinical skills”
(Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–781)
Hmmm.
12/ Another more recent one broke it down further:
“a supportive conversation that clarifies the trainee’s awareness of their developing competencies. . .”
But wait. There's more.
(They had more than 280 characters to say on feedback.)
13/
“. . enhances their self-efficacy for making progress, challenges them to set objectives for improvement, and facilitates their development of strategies to enable that improvement to occur”
(Lefroy J et. al. Perspect Med Educ. 2015;4:284–299)
Hmmm.
14/ I think I’m hung up on these parts: “intended to improve” and “enable improvement.”
Hearing that stuff on the last day? I never had a chance to make a comeback, man. Or improve.
Like, my mom didn’t wait until after a meal to say to close your mouth while chewing.
Feel me?
15/ I was fine with the banter about Korean BBQ and Lion King.
Machu Picchu was cool, too.
But may I offer YOU some feedback?
While you’re working to build up the learning climate? Don’t forget to build up the learner, too.
Okay?
16/
P.S. I don’t like cilantro. But I do want to get better.
Disclaimer:
I'm not the student. Though I experienced things like this in the past, this was based on stories from learners I advise. It also reminds me of the times when I, as a faculty, neglected to be transparent & timely with feedback. Writing in first person helps me see.👊🏾
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Me: "How're you feeling today?"
Him: "Well. I been better. That medicine y'all gave me made me run off!"
My team looked puzzled.
I did not.
Me: "Oh no! You talking 'bout the medicine we gave you for your gout flare up?"
Him: "Yeah! That one!"
2/ Him: "Shit, you coulda warned a brother."
Me: "Dang. I really should have. I'm sorry."
Him: "Yeah, if it wasn't for that bedside commode it woulda been a clean up on aisle 1!"
He laughed.
I was glad he was making light of it.
Me: "I apologize, sir. Colchicine can do that."
3/ Him: "It's cool. My knee is feeling a little bit better so that's good."
Me: "I'm glad. And again, I'm sorry for not giving the heads up."
Him: "I'm okay, doc."
I turned to my team.
Me: "'Running off' is diarrhea."
Them: "Ohhh."
Him: "Oh my bad, y'all."
1/ Her: "Why haven't you left for L.A. yet?"
Me: "Huh? Oh. Yeah. I'm pretty much almost done. It's okay."
*silence*
Her: "But, like is it?"
Me: *sighs* "Me rushing there won't change anything."
Her: "Depends on who you ask."
And after that, we both went back to charting.
2/ I was on the hospital service last April when I got the news. Dad had this sudden onset of disabling vertigo. We'd learn it was a cerebellar stroke. My sister was there in LA. At the bedside and wringing her hands as next-of-kin.
So she kept me posted.
And I kept rounding.
3/ On that first day, I walked right in and told my team.
Me: "My dad has been admitted to the hospital. It seems that he's had a cerebellar stroke."
And I said it in that "but I'm fine" voice. Because at that time that's what I was telling myself.
1/ Me: “I’m glad to see you.”
You: “You know what? I’m glad to see you, too.”
*silence*
Me: “You know how you’re loved, don’t you?”
You: *smiling gently* “I do. I think that’s what makes this so hard, you know? Can’t feel a loss like that without feeling a love like that.”
2/ We both let out big exhalations. After a few beats, you swung your head in my direction.
You: “How are you?”
Me: “Me?”
You: “Yeah. You.”
Me: “I’m fine. I just wish... um… you didn’t have to feel what you’re feeling.”
You reached out for my forearm. And then sighed again.
3/ You: “Yeah. But I’ll be okay. We were soul-connected. That will comfort me.”
I nodded. Then we sat in silence.
You: “But for real—how are you? Like with all this cool stuff you’ve been doing.”
Me: *puzzled look*
You: “It has to make you miss your dad and your sister.”
1/ I just finished this beautiful, courageous, and searing memoir “I Can’t Save You” by @CQ__MD. It was . . . in a word. . . sublime.
Whew.
And full disclosure—as his former med school advisor & friend—I love Dr. CQ.
But.
I also love books and honesty.
And he knows that.
2/ @CQ__MD will be the first to tell you that I won’t endorse anything—even a book my my beloved little bro CQ—unless I’d read it myself and believed others should, too.
And now I have.
And wholeheartedly I do.
But before you jump in—and you should—let me say this. . .
3/ There are some parts that explore depression, thoughts of suicide, and self-harm. No, not recklessly. But yes, with raw honesty. So you need to know that up front.
He does NOT play it safe around his lived experiences as a Black man in the ivory tower.
1/ I had imagined what this day would be like. Played it out in my head and saw various iterations of me exploding in celebration.
In some versions, I was doing the running man or, quite literally, running in triumphant circles, #MatchDay envelope in hand.
"Wooo hooo!"
2/ I also saw these visions of me quietly weeping, one hand extended to the heavens in gratitude. My lips quietly murmuring prayers of thanksgiving.
See, I was my ancestors' wildest dreams. And not even just my enslaved ancestors but the Jim Crow survivors who raised me, too.
3/ So, yeah. This was about to be big.
I was even on the #MatchDay party committee. And since we were broke, that meant soliciting donations from faculty & parents & anybody who felt proud enough of us to shell out a few coins.