Words, words, mere words

This link describing the difference in language in performance reviews of men and women came across my Facebook and Twitter feeds.  To summarize the HBR piece it draws from in one sentence, men are more likely to get specific information about what they are doing well and what they need to do to get to the next level than are women.

Men get feedback on technical aspects of their performance. Women get feedback on their communication style (when is the last time you heard of a man being described as “aggressive” in an evaluation?). Men get constructive suggestions.  Women get constructive suggestions and are counseled in effect to sit still and look pretty. Men are acknowledged for their individual results.  Women are described for their team accomplishments. Men are expected to be independent and self-confident.  Women are criticized if they aren’t collaborative and supportive.

The real issue with the implicit bias that appears to pervade evaluation in so many areas of business and tech is the impact it has on women’s professional development. Although little work has been done to date, I suspect that the same phenomena are at work for medical students, residents, and women in academic medicine.

And, of course, since I always try to bring solutions for the problems I share, I’m particularly fond of solutions modeled on those recommended in the HBR article. For those of us in roles of evaluating our learners and our peers, how can we best do this to mitigate the unconscious bias?

  • Use specific criteria (or anchors) to evaluate individuals. What does competence look like for a specific skill or activity? What does mastery look like?
  • Set three measurable outcomes to review for each individual.  These may vary from one to another (no two individuals are alike); the key is that they should be measurable.
  • Relate feedback to goals or outcomes. Instead of saying, “Great job during that OR case!” perhaps we should mention to the resident, “The time you spent getting good exposure of the trachea made the actual placement of the tracheostomy safer for the patient and technically easier for you.” Or instead of saying, “The whole room thought you were panicky during that trauma activation on a patient who was clinically stable,” we could say, “We should work together on you maintaining command of the room during low-level trauma activations so that you can do the same when we have unstable patients. When you seem anxious, the team picks up on that and it impacts their care of the patient.”
  • Written reviews should all be of similar length- which also means similar level of detail.

I know that I’m discussing these issues largely in broad strokes. I’m also not finger-pointing at anyone in particular, especially because it appears that women bosses and men bosses are equally guilty in the business world. I’m also curious to look at evaluations I’ve written over the last couple of years on students and residents to see if I’m guilty. If I manage to pause and adapt a comment I might make tomorrow morning during our residency review meeting, it’s a victory for me and for that learner.

Most importantly, I want to put this in front of you, my readers, because the best way to beat unconscious bias is to realize that it exists.


Good job, buddy!

As promised in last week’s great reveal about our lack of faculty-led didactics this year (thanks to all who have sent comments/ encouragement/ not thrown rocks at me), I’m absolutely convinced that one of the keys to making this transition effective lies in meaningful feedback.  Those who have worked with me know that today’s blog title is my running joke about meaningless feedback- that actually isn’t feedback at all, but is a global evaluation.

I recently came across the first concise definition of feedback that I’ve found that helps to operationalize the concept.  Feedback is, quite simply, “information about how we are doing in our efforts to reach a goal.”  It’s important to realize that it can be any information, sometimes subtle and sometimes deliberate.  What is feedback not?

-It is not advice (“Next time I would put less text on your slides.”)

-It is not an expression of preference or enthusiasm (“I LOVE your goals for yourself!”)

(Note:  Both of these examples of “not feedback” are items I am commonly guilty of with mini-clinical path correlation evaluations and with student written assignments.)

John Hattie, an Australian educator, provides a brilliant response to the question, “How can teachers learn to give and receive feedback in an appropriate and timely manner?”  His response has two key points.  First, think about feedback that is received, not the feedback that is given.  What message did your learner take away?  And second, feedback must include a “next steps” phase for the learners- his summary is that students want feedback “just for them, just in time, and with just a nudge forward.”

Grant Wiggins provides a more comprehensive list of the seven features of effective feedback.  This list includes the following (please see his original for more detail on each):

  • Goal-referenced
  • Tangible and transparent
  • Actionable
  • User-friendly
  • Timely
  • Ongoing/ dynamic
  • Consistent

If you look at the theme that underlies these features, they are all associated with achieving progress towards a goal.  Again, that idea of having the end in mind is what we need in order to know how to help people get there.  I short, feedback provides an ongoing means of formative assessment.

A paradigm I hope to play with a bit more as I work to refine my own feedback skills is the RISE model of feedback.  Most of you know that I am drawn to visual things, and this one allows students to push themselves and each other.  Perhaps we’ll see the RISE turn into the peer evaluation framework for the mini-clinical path correlations?

Now, to improve my comments above…

-“Next time I would put less text on your slides.  It can be hard for your audience to read all of it, and it distracts them from listening to you as you discuss the most important points.”

-“I LOVE your goals for yourself!  Sitting in on three family meetings and debriefing with the faculty and the family afterwards is easily actionable during your clerkship time and will expand your understanding of both perspectives.”

(And if you’re on service with me right now, get ready.  Tomorrow’s “What if?” involves me asking for your learning goal for the rest of the week!)


Behavioral feedback in medical education

Yesterday I co-moderated a workshop on behavioral feedback with Jane Dyer, one of our excellent midwifery faculty in the College of Nursing.  It’s pretty heavy on images and not text, but I think you can get the main idea of what I had to say- hopefully it will benefit anyone who is a teacher and provides feedback.

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