Hello, welcome to the Medical Mentor Coaching Podcast. I'm Stacey Ishman, and today we're gonna talk about unlocking the secret to effective feedback and maybe a little bit about whether I should have worn bifocals because I have to do this in order to read anything on the screen. But that's another co podcast.
Now in academic medicine, we are surrounded by feedback and we like to think we're good at it. We're kind, we're generous. But quite honestly, you get tired. It's the middle of the night, you're frustrated. You just have had this like same problem a hundred times and we lose that. Kindness, that perspective, or we forget that the way we're giving feedback is just not, in a way it can be received.
I tell my kids all the time when they say something and it doesn't turn into whatever change they're looking for, that, you know, oftentimes people can't receive what they're saying if you don't say it in a way that they can hear it. And so a good example is that I had a boss who would send me a text when I was a fellow.
He would say, we need to talk. Every single time, somehow my brain went like, I'm fired. I don't know why I thought I was fired. I was on call every day for the year. Nobody wanted me to be fired. I didn't wanna be fired. They didn't wanna be on call. Like there was no reason I would be fired. But I'm gonna tell you to this day, like if my boss sends me a message that's like, we gotta talk.
I am pretty sure I'm getting fired in my head. Like I actually work with, um, a whole bunch of other physicians doing real estate syndications and one of them sent me a text that said, we gotta talk or can you talk? And I even told him, I'm like, there is, I can't even get fired from this. Okay. Like, we're working together, we're a partnership.
And I said, I just have this fight or flight feeling when I hear somebody say, we gotta talk without any context, that something terrible is gonna happen. And so think about that. Think about what people are hearing. Even if you say something you think is innocuous like we are, we have to talk. Probably doesn't make people think, I am throwing Stacey into fight or flight.
Her reptilian brain has just jumped into overdrive. Her amygdala is telling her there's a dinosaur around the corner, but that's what actually happens to me. And so if you think about the context in which you're gonna give feedback or the way in which you give feedback, it makes a huge difference. And so one of the frameworks that I have found useful and that I use in the people that I coach is to, um, talk to people about the ideal version of where you want them to be instead of what they've done in the past.
So it is not about, Hey, you got behind in your research 'cause you were starting that new clinic. It's like, Hey, let's look at research productivity for someone who wants to lead in our field. You're doing some great jobs publishing. The next step might be to look for what kind of grant we think is realistic and then come up with a plan on how to do that.
Now, the first one was telling me I'm not doing a good job, and I probably stopped listening immediately because now I'm like. Do I have enough publications? What am I doing? What should I be doing? My, on my research? Why am I spending so much time on the clinic? Um, am I gonna get fired? Like clearly, that's something that's in my head.
So really the, the second statement says, we need to make a plan. We know your goal, we wanna get you to your goal. We need to make a plan. How are we gonna get there? And so when you can see what your target looks like. You are much more likely to be able to think of something useful in terms of how to get there now.
Um, the other thing to really think about, you know, what kind of feedback are we giving that's really not working? So things that are too vague are a problem, like, do better. Regardless of what the topic is like, who knows what that means? Well, I don't know how to do better. I think I probably am doing the best I can do, or at least I'm trying.
And, you know if, but if you're like, Hey, what I need you to do is make more eye contact in clinic, so the residents feel that you're really listening that I can do. But if you tell me to do better, really, really hard, um, the other thing is too negative or past focused. You didn't meet your target VUS last quarter.
Okay. How about like your target RVU for this corner is X. It looks like we probably have a gap to make up. What do you think is the best way for us to get there? Should we be adding half an hour to your clinic? Should we be more effective in your scheduling times for the or? Do you already know what the issue is?
Did you have to take a month off because you know somebody in the family was sick or did you get to take a month off because you took a sabbatical or whatever it might be? I can tell you when I was early in my career, I had a child and then I was, I had a sleep practice. And so the structure was that you would walk in the door, I would meet you, I would order a sleep study.
That would take a couple months, you would come back, we'd go over the results, and then we'd figure out next steps. And then, you know, three months down the road. We had action items. We had billable things that might be on your list. You might be getting A-C-P-A-P or an oral appliance or a surgical option, whatever it was.
There was a lag between when I had people walk in the door and when more of the things that were billable events in my department might happen if they have a good option. And I was talked to when I came back from my maternity leave at about four months, about how I wasn't working hard and my productivity was a problem.
That I had an attitude problem and I was like, I don't have an attitude problem. Well, now I did honestly, um, I was like, I have an RVU problem. And the RVU problem was based on just the structure of my clinic. 'cause quite honestly, by the time we were having this conversation, my RVU had gotten back to normal.
They'd gotten back to the number they were at before I'd had a child. Um, but I will also tell you all I got out of that was that this person doesn't understand me. They don't see me, they don't understand. I hadn't slept in. At least four months. So probably wasn't the best timeframe or mental frame for me.
Um, but the feedback, I don't think I got anything useful out of it. I knew my RVs were low, but all I could think about was how little understood I was. And, and quite honestly, it turned me into somebody who no longer liked what I was doing or who I was doing it with for a while. Now, that was too vague.
That was too negative or past focused. The third one is something that's too personal. You're not a natural teacher. What, like first of all, there are things that can be taught, but second of all, what if I love teaching and I think my style is really good. If it's not effective, it may not be 'cause I'm not a natural teacher.
Maybe because somebody taught me to use a Socratic method and the residents don't find it very useful or. I am too past focused in my feedback, and I have an opportunity to be future focused. I mean, there are things that you can give that are gonna be much more specific and useful. Um, and then the consequence of all of that is it shuts people down.
It fuels burnout. It doesn't drive improvement. And for me, sometimes it gave me a bad attitude, but. That might be the New Jersey in me. So I wanna talk about the framework I do recommend, and that is compared to the ideal version of the role and why this works is 'cause high achievers love clear targets and almost everybody I give feedback to is in a medical setting.
There's medical students, there's residents, there's my fellow attendings, there's MAs, there's, you know, even the front desk person who works in a medical environment is somebody who cares about people or else they can find an easier job. It also helps protect your professional identity and we spend years trying to build those things up and really help preserve them.
And what we want is for our MA who is doing a, at least a good job in some areas, to know that there's an area that she just improved, it would really like knock it outta the park. And then it creates collaboration instead of defensiveness so that people don't tune out but are actually helping you come up with solutions that'll make.
Everybody more successful, whether it's something they have a personal interest in or could personally change, or they're giving me some ideas on how I can do something that will actually result in a positive for the, for the practice and for me. So here's some examples in action. And telling, instead of telling a researcher, gosh, you really haven't published much this year, you're gonna say, Hey, a leader in the field publishes consistently.
Um, the expectation, our institution is two to three publications a year. Um, and this is an opportunity for us to look and see what you have in the pipeline, what could be coming up, and then figure out, you know, what that should look like or if you need help or where your next idea should be coming from.
And for an educator, you might say your teaching scores have dropped this year. Okay, I'm no longer listening. Or you could say, Hey, really out seating teachers innovate in curriculum and mentor outside of their schedule hours. Are there things that we can help you do to innovate this semester? Or what do you already have in place?
Or what resources do you need in order to be able to accomplish that? Now, for a clinician, if we have somebody who is not hitting the RVU target, we might say, you're not efficient in clinic. Okay, but as again, not very specific, and in top of being vague, it's gonna shut me down. So what, instead we say, clinicians who stand out, balance patient volume with teaching and documentation.
So let's talk through workflows so you can hit that balance. I can tell you that I used to dread students coming to my clinic because I couldn't figure out how to make it work until I realized. Set expectations, uh, right up front. You need to finish the note before you move on to the next one. You're not necessarily holding me behind.
I'm not worried about all the duck documentation at the end of the day, and you are fully learning from every patient. So there's ways to say like, Hey, what's the, what's the thing that's holding this back? Or, here's the idea. Tell me what, how we get to the ideal. Gimme your ideas. I'll give you mine. So here's the three steps.
Define the ideal, this is what great looks like. And then give some forward focused feedback. Here's how we can get you to that point. Or here you're almost at that point, how do we make this better? And then tie it to shared values. So link it back to something in their personal career goals or things that you know they really value.
And then. If you really, really wanna make this work, give them an example. Talk about something that didn't work. I gave several in mine that didn't work, but I can tell you I got feedback that the residents didn't think I cared and I was demoralized at the beginning of my career. It was the thing I really got the most excitement from, the most value from.
I really enjoyed connecting with the residents. I felt like I learned, it gave me energy and so, you know, I didn't really know what to do with that. The residents don't feel like you're connecting with them. Okay, what's my, what specifically can I do that's better? How do I connect with them? And what it turned out was in my quest to be effective, um, my coach said, okay.
And my, my coach, well actually my chair at the time gave me a coach and we sat down and we said like, what are you doing when you're trying to connect with the residents? And here's what I was doing. I was trying so hard to be efficient. I was talking to the residents, but they were talking to my back. I wasn't turning around.
I was sitting at a computer, I was typing. I was on the EMR or I was checking an email or whatever I was doing, and I was talking to them. I was being intentional. I was thinking about the feedback, but I was distracted so I wasn't fully present. And I had my back to them, like the body language said, this is not important to me.
And what I realized is if I just turned around and gave them my full attention for. Two minutes, the question they were asking to be answered, the communication. I wanted to make sure what happened was happening and they felt seen and heard. I had stopped long enough to actually listen. And quite honestly when I turned back around, I was probably less distracted at with doing whatever I did to adjust as efficiently.
But they understood they were important and I gave them feedback. I said, you know, you did a great job at this. And I would ask everybody, what do you think you did? Well, what do you think you work on? I started with, what do you think you do well? 'cause our brains already go to the negative, right? Like, I'm pretty sure I got fired 8,000 times.
And by the way, I've only laid off once. But, um, if you look at all those things. That's the opportunity. And so instead of telling a resident, Hey, that was really kind of too slow, say like, Hey, as you get more adept at this, you're gonna balance speed with safety and teaching. Let's focus on efficiency steps.
They can help you get there. Or you know, if you're worried about trying to do something on a committee, telling somebody they're over committed. It doesn't help them get anywhere. But if you say, Hey, you know, when we lead these committees, it needs to align with your research. Let's narrow down all the different things that you're doing to two that really support your trajectory.
So think about some scripted versions before you talk to people. If this isn't a natural way to talk, and I'm gonna tell you, despite the fact that I've spent a year doing this, I still walk in the room and think, Ugh, that's not going well. That's not the feedback that's gonna be useful for anybody, but it might be something that's your starting point.
So if what I'm really thinking is. My clinic really didn't run efficiently yesterday. That's not the thing to tell people. But if it's, Hey, you know, I think we're gonna have the best experience to our patients if we're able to get 'em in and and get 'em out quickly. Where do you think we're getting stuck?
What do you think we could do to help with flow? Like what are some processes, what are some themes? Can you watch clinic today and see where you think things are getting bottled after? Or can we just do a quick audit and see what's happening? Like there's a lot of ways to have a productive way of doing it.
Quite honestly, some of the people you talk to might already know the things that could be done to fix that. So that is my recommendation to everybody today, is to really look at how to give effective feedback so that when we are talking to people, they can hear what we think that we are trying to share, and that they're able to take that information, move it forward in a positive way.
Thank you very much for joining me today. Um, if you thought this information was useful, please share it with somebody who could benefit from the information and please subscribe to the podcast. I know that I am on Spotify and Apple, but please do it on wherever you like to watch your podcasts. And I have a video version of this on YouTube where you can see that I, um, using the bifocals part of my glasses and can't actually see very effectively what I've learned today is not to do my podcasts and my bifocals.
Or be able to say bifocals. Um, but, um, if you would like to connect with me, please check me out on my socials. I'm on Instagram at @sismancoach. I'm on Facebook and I'm on LinkedIn. Um, or if you wanna get in touch with me, go to my website @ medicalmentorcoaching.com or you can find the blog or the podcast or just check out my program.
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