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Residency Rap

The Value of Feedback

by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington Hills, MI

Last week I wrote about confidence in our residency training. This week’s issue is a kind of sister editorial along the same vein. Throughout my residency, I’ve received different types of feedback from different attendings. This “feedback” has ranged from positive, constructive input (“good execution of that procedure; next time concentrate on stroke efficiency”), to negative (“which one are you? Larry, Mo, or Curly?” or “who taught you how do surgery, stone hands?”). I’ve been lucky in that most of the feedback I’ve received has been the constructive sort, which has helped me grow as a physician.

Feedback is an integral part of our training. I don’t think I could count how many times I receive feedback in a normal day. It’s also an essential component to help us grow as physicians. For example, every interaction with patients provides opportunities for feedback from a range of people. At Botsford General Hospital, my human resources department is in the process of implementing a “360 degree feedback program.” This includes input about the resident from a variety of people including the patient (in the form of surveys), nursing staff, attendings, and the resident themselves. Perhaps your residency program has already implemented something along these lines?

Over the past several years I’ve tried to hone my interviewing skills by observing patient responses to my questions. For instance, if I were to ask a patient if they have poststatic dyskinesia, we all know that patient would look at me with a completely blank stare. But if I asked, “Does your heel hurt when you first step down in the morning?” I would most likely get a clear positive or negative response. Similarly, I’ve learned not to use medical jargon when explaining things to patients. I’ve seen this happen with seasoned attendings with the response that the patient says nothing, appearing to understand but really doesn’t. This too is a kind of feedback.

When is silence part of feedback? One of my attendings allows us to make the decisions during surgical cases until it appears we’re about to get ourselves into trouble. This type of feedback is often difficult for our more freshman residents to accept at first. But by the time we’re seniors it becomes an excellent educational tool which builds our confidence and competence with each case we perform.

Some people thrive in this environment while others truly struggle and want to be told exactly what to do. They prefer more concrete feedback while others like a little extra rope. Both forms of feedback are acceptable as long as a positive and encouraging environment is created. What feedback do you prefer? Write in with your experiences and opinions.

Chief Residents Sound Off
A Chief Resident Round Table

I’m asking all chief residents who read this to contribute to a unique editorial in the Residency Rap: a round table discussion on being a chief resident. Just as several of our trade magazines have round table discussions on different topics I’d like us to do the same, and I’m asking YOU to participate as the expert.

Please write in an answer the following questions in as much detail as you feel necessary:

What is it like to be a chief resident at your program?
What are some of the dynamics of the residents and attendings you work with?
How many residents are in your program?
How do you stay organized while balancing your personal time and work?
What’s your educational/didactic program like?
Do you think being chief offers an advantage when looking for jobs?
Do you receive any extra financial or other compensations?
What do you like and dislike about the position?
What hints or tips do have for future chief residents?

Here’s your chance to toot your residency’s horn a bit. Contribute hints and tips on being a chief resident. Impart your wisdom onto the residents who’ll be taking your positions next year. it would great if you included your CV along with your responses...at least tell us your name, your program, and where it is. The more chief residents that respond the better. Please have your responses emailed to me by March 31st. Let’s use the Residency Rap to its full potential!

As with all PRESENT publications, all issues of Residency Rap will be stored on the PRESENT website, so if you miss an issue or you want to refer back to a prior issue, it'll be at:

http://www.podiatricresidency.com/residencyrap/

Talk to me,

Jarrod Shapiro, DPM
PRESENT Resident Editor
jarrod@podiatry.com

From:         Robert D. Phillips, D.P.M.
                     Residency Director
                     Coatesville VAMC
Subject:    Confidence vs Competence

Some interesting comments you made about confidence. After 26 years I have come to realize that confidence is a result of both experience and knowledge and also self-worth. My observations of many students and residents is that there is an inverse relationship between knowledge/capability and confidence. It seems that some of the most confident residents are some of the most uninformed, misguided, and even incompetent. Some seem to make brash decisions and statements with the smallest of knowledge bases and understanding of the long-term results of their actions.

I believe that there’s real need for more honesty in residents. After those 26 years of practice, I realize that the book of things I don't know keeps growing faster than the book of things I do know. Confidence comes when one can honestly state that there are so many things they don't know, without losing their self-worth. It comes with being able to ask others' opinions without feeling humiliated. I believe that residency directors can do much to boost self confidence by giving honest praise publicly and honest criticism privately. It also comes from resident teachers setting an example of true honesty with their patients and with their colleagues. It comes from teachers not bluffing their own way through tricky and touchy situations. It comes from being able to humbly admit that all doctors make mistakes and misjudgements and no doctor knows it all. I know the law profession would like the public to believe otherwise, but such is not reality.

I believe that a director can best build confidence by helping the resident be honest with himself/herself about what they do know and also about what they do not know. When a person can do this without judging themselves superior or inferior, then true confidence will shine through in a natural way.

Robert D. Phillips, D.P.M.
Residency Director
Coatesville VAMC
Robert.Phillips2@va.gov

From:         Brad Fine, DPM
                    3rd year, Chief Resident
                    Hollywood Medical Center
Subject:    Confidence vs Competence

I agree with you. You don't want to appear too confident, because that also aggravates attendings. There was a certain point--at least for me-- during my residency, that I felt capable of doing just about every procedure that we can do. Once you get there, there is no appearing confident, your experience, comfort-level, and confidence shines through

Editor's Response

Wise words as usual from Dr Phillips. I wish more of your directors and attendings would participate in our online Residency Raps. (Hint Hint Nudge) It’s nice to hear an honest viewpoint from an experienced attending. Too often, I interact with attendings that have no explanation for their actions and can’t come up with a reasonable rationale for what they’re doing besides “this works in my hands.” I’ve also had excellent experiences with attendings that welcome my input with interest and respect. If you find an attending like that, hang on to them; they’re a true asset to your education!

Dr. Fine brings up the excellent point of the delicate balance we have to follow as residents. I think the hardest point in achieving this balance is during the second year of training, when we’ve received a good bit of training but still have a relatively small store of experience to draw from. It’s often hard not to appear cocky. On the other hand, some people just come across that way no matter how hard they try not to.

- Jarrod

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