Thread by @davidschulman

As I enter my final week of Program Directorship, I decided to put together a few "lessons learned" series of tweets. I won't call them tweetorials, as they aren't evidence-based or well-researched. But they are the result of 14 years of experience. Enjoy in that context. 1/

My first #tweetstorm relates to feedback. But not giving feedback; lots of smart people have written widely on how best to do that. I want to focus on how to receive and incorporate feedback. Over my time as PD, I have had a chance to counsel more than 75 fellows in this art. 2/

Whenever you get feedback, ask yourself three questions:

1) Do I agree with this feedback?
2) Do I think this feedback relates to a worrisome issue?
3) Do I know how to address this issue?

Using these questions, the feedback will fit into one of four "buckets". 3/

If you don't agree with the feedback, that's bucket one. It doesn't mean to ignore it. Unless the person giving you feedback is a total jerk or has a vendetta (both of which are hopefully rare occurrences), you have work to do. Ask "Why might someone think this about me?" 4/

Folks, I assure you that the person giving you feedback isn't unique. If that person thinks something about you that you don't agree with, there are other people who think that same thing. It may be 10% of people. It may be 1% of people. But it is still some people. 5/

So think to yourself "What did I do (or say) that might make someone think this?" Sometimes that's enough to see the light. Because while you didn't intend to come across the way you were perceived, you still did come across that way. At least to that person, at that time. 6/

Now you may reasonably say that what you did (or said) would not be perceived wrongly by most people. And you may well be right. You may decide that you are willing to have some (hopefully small) percent of people to see you in this way. And that might be fine. 7/

As long as you are aware that some folks out there will feel the same was as the person that wrote that feedback, "you do you". 8/

Let's turn to question 2. You agree that the feedback is an accurate assessment of your performance. Now, is it important? While there's stuff that probably shouldn't find its way into feedback ("His tie is always crooked"), that's not what I'm talking about here. 9/

Over many years, I've had a number of trainees express irritation about something they deemed relatively unimportant that found its way into feedback. 10/

What I've told them it that I encourage my faculty to document any opportunity for the fellows to improve. Remember that most feedback is for internal use only. No one outside the training program sees that stuff. So why, you might ask, do I ask faculty to write it at all? 11/

Let's say a trainee is a little late for a few days on a rotation for very valid reasons. Maybe traffic was bad, flat tire, whatever. Generally not a huge deal. So why have faculty document it at all? Precisely because it is important to identify patterns of behavior. 12/

Being late a couple of times to a rotation isn't likely to find its way into semiannual feedback. But being late to a couple of times to EVERY rotation probably should. Many program directors have folks document things to make sure that patterns of behavior aren't missed. 13/

You were having a bad day and were a little snappy to a resident? You slept through a page one time when you were sleep deprived? Neither of these should be ignored, but if you know why something happened, and you can prevent (or minimize) its recurrence, it is less worrisome 14/

So if you read feedback and you think to yourself "I agree with that, but it was a one time thing and I've fixed it already" that's one of the things that bucket 2 is for. But there's one more category, and that's one of my favorites.... 15/

Ready? How many times have you heard "Dr. So-and-so is too quiet on rounds?" I have seen it written dozens of times. No exaggeration here. DOZENS OF TIMES. Most people about whom this is written agree with it.... But is this worrisome? Is it a big deal? 16/

The answer is that it depends. There is nothing innately wrong with being less outspoken on rounds. Some read more into it than is there. They may perceive the quiet person as disinterested or less knowledgeable. Sometimes that's true. But far less often than folks think. 17/

So if you read feedback about yourself that you think is accurate but you don't see as a priority because it represents something different than the writer believes, that's also bucket 2. 18/

Next is bucket 3. This is the stuff you agree with and you think is important, but aren't sure how to fix. The most important thing you can do to work on these areas is to engage trusted confidantes to assist. Ideally, these are folks who can observe your behavior regularly. 19/

Meet with them and tell them that this feedback is something that on which you want to work. Have them watch specifically for related behaviors, and to bring them to your attention (either in real-time or soon thereafter in private) when they manifest. 20/

And if you aren't sufficiently comfortable sharing these areas with people with whom you are directly working, there's no reason you can't speak to a Program Director or other mentor about these opportunities for improvement. 21/

Sometimes these folks have advised others on this specific issue; sometimes, these folks have even had to work on the issue themselves (this has been true for me a lot). Regardless, brainstorming ways to help people be improve is something most mentors are good at. 22/

I've saved the best bucket for last. Bucket 4 isn't the most complicated. It's actually pretty simple. But there's nothing I love more than a trainee reading feedback, thinking it is on the money and important, and having a pretty good sense of what they want to do about it. 23/

This went on longer than intended, but I think it accurately summarizes conversations I have had with fellows many times throughout the years. And I welcome your thoughts about what you disagree with. I'm still learning. And I'm very open to feedback. 24/24 #Schulmanout