The Good Jobber and the Critical Curmudgeon
Most radiology resident evaluations are a one-way trip on the “keep reading” express. Maybe, in harsher climates, “read more,” which is just a coded way of saying I wish you were better and more knowledgeable with the word “reading” used as a stand-in for “learn more useful stuff please.”
Many attendings are nice but not kind. We don’t want to hurt anyone’s feelings, so we don’t share specific critical feedback other than in cursory, generic, or essentially universal ways.
When more substantive critical/negative feedback is given, it can also be idiosyncratic concerning various pet peeves (i.e. not generalizable or particularly helpful) or a list of mistakes (without direction on how to fix them). Because most of us are cowards, these shortcomings are often a total gut punch of a surprise.
Feedback as a first-year radiology resident is often more a measure of compliance than growth.
But even when helpful, most rotation evaluations feel more like a grade/assessment and less like a pathway forward.
Ideally, you’d get feedback continuously. You don’t want generic ‘good job’ feedback or ‘you suck’ feedback. Neither is very helpful except to tell you that things are generally working or generally not working, and that’s not really going to help guide action except in the broadest sense. When it comes to in-person or at least specific one-on-one style feedback in an ideal world, you would simply get great, actionable feedback. But we don’t live in an ideal world and most feedback you receive will be generically positive or negative in ways that mostly reflect the bias of the person providing the feedback and their personal preferences.
(A classic useless example is a female resident hearing that she should “be more confident” from older male attendings)
So, in all likelihood, you will feel that your evaluations fall into one of two camps: The Good Jobber (gee, thanks) and the Critical Curmudgeon (okay, jerkface). Neither is all that helpful. Chances are, it’s going to be up to you to get the feedback you want/need.
The Painful Request
There are situations where–despite the unpleasant awkwardness–it is in the learner’s best interest to ask for feedback. When you directly ask for feedback, you have a greater chance of receiving helpful specific feedback if you ask for specificity. So don’t just say, “Do you have any feedback for me? How can I get better?” Rather, consider asking about specific ways to improve: How can I improve the conciseness of my reports? How is my organization? Have you noticed any instances where my reporting style may be unclear to clinicians? Is there a certain kind of perceptual mistake that you’ve seen me make multiple times that I should incorporate into my search pattern or my proofreading checklist to do better quality work? A direct question is more likely to get a directly helpful response. Does that sound tool-ish when written out this way? You bet it does. But surgical requests are more likely to generate meaningful responses.
At any given time, you may be working on a specific part of your approach to radiology. You may be working on developing your first-year search pattern. You may be working on the library of if-then pattern extenders that help you address pertinent disease features or whittle down a differential diagnosis. You may be working on your mental checklist so that you do not omit parts of the report. You may be working on trying to hone down and describe findings that matter and leaving out truly extraneous detail. You may be working on making reports that are as short as possible while containing the information that will help decide patient management.
When you ask for feedback or when people give you generic feedback, consider tailoring your request or your follow-up questions to get advice and feedback on the issues that you’re working on actively right now. We simply can’t actively work on every aspect of our jobs every day. That’s not how deliberate practice works. We all get better and more refined in our routines over time organically. Your process, whether it’s optimal or not, will become ingrained through repetition.
But that’s not how people who are experts actually improve to the next level of effectiveness. They do so in a piecemeal fashion. So if you want to work on that process and not just solidify through the inevitable accrual of time, then you may need some guidance on how to deploy that extra thoughtful work. If you aren’t sure what to work on, then consider asking for what is the one thing that is your weakest in a specific context: As in, what sort of finding am I missing? What sort of error am I making in my reports? What is the most irritating thing that you find yourself editing when finalizing my work?
Reception & Acceptance
1. Listen for Patterns
We can be fragile: we can take feedback too personally and miss opportunities to improve.
We can be stubborn: we get used to hearing the same things and start internalizing them, then start ignoring what others say and also miss opportunities to improve.
Patterns are important: Don’t let a single bit of negative feedback crush your self-worth. But, the more often you hear something, the more seriously you should take it. Even when the feedback feels isolated, keep in mind that most feedback you get will fall into the generic nice-but-not-kind good-jobber variety just by dint of attending personality and not your performance.
2. Experts Are Often Wrong
Never forget that not all feedback is good feedback, and many experts do not understand how they arrived at their expertise. They may not know which practice methods would be most efficient to achieve mastery even for themselves let alone for any individual learner. They are trying to help, but meta-learning is a challenge.
Most people do not really know or understand how they learn. You might know how you like to learn, but how you like to learn isn’t necessarily the same as how you learn the best.
Commentary on your deficiencies is likely spot on, but proposed solutions for how you should fix them are a different story.
3. Stop Wrong-Spotting
In defense of our ego, we often look for inaccuracies that allow us to psychologically reject the entire package. Instead of looking for reasons the person is wrong in order to create a straw man (even if they are in some details), look for the parts of feedback that are helpful or potentially true. The goal isn’t to be right; it’s to be better.
The Most Important Feedback is the Case-Loop
It’s not just what you’re doing, but how you’re doing it. It’s a difference in perspective. The way a novice and an experienced reader approach an exam is not the same, and the goal of the learning process is to move efficiently along the path from learner to expert.
One of the amazing baked-in capabilities of radiology residency training is that previewing and dictating a case and then reading out gives you 1) your attempt, 2) a fallible but more experienced person’s attempt, and 3) allows you to see the difference.
Obviously, you cannot see directly into the mind of your attending, and even how they verbalize their thought process or describe their search pattern is not necessarily the same as what they’re actually doing. Our subjective awareness of how we think is not perfect. We are in part black boxes even unto ourselves. At the risk of getting too far into metaphysics, we don’t think we think how we think.
Nonetheless, every case you read is the most plentiful opportunity for feedback. It’s not about just missing a certain finding or whether you were right or wrong. It’s about where you are now and seeing the next steps to getting where you want to be.
Feedback is not just what you get at the end of a rotation, it’s the difference between what you did and what–after the fact–you wish you’d done.
One Comment
Great read!