Canadian Medical Association

Both positive (reinforcing) and negative (corrective) feedback are central to a physician’s professional development, helping to build competence and confidence at all stages of a person’s career. 

Feedback helps people acknowledge discrepancies between actual and desired performance, and identify ways to improve and narrow those gaps.

Without critical feedback, people may develop overly positive perceptions of their own performance and fail to make necessary improvements. This is particularly important for physicians, as their performance directly affects patient care and the health system. 

Barriers to delivering critical feedback

Delivering negative feedback is a challenging and sometimes uncomfortable task in health care settings. People might avoid giving critical feedback for many reasons, including:

  • Fear of upsetting the person receiving the feedback
  • Fear of damaging professional relationships
  • Defensive behaviour or resistance from the person receiving feedback
  • Physical barriers (e.g., noise, lack of privacy) 
  • Personal agendas
  • Lack of confidence

How to deliver critical feedback

Delivering effective critical feedback is a skill that requires practice. These guidelines will help you refine this skill so you can help your colleagues learn and grow. Feedback can be informal (on a day-to-day basis on any aspect of performance) or formal (as part of a structured assessment). 

General tips for giving informal and formal feedback:

  • Avoid simple praise (“that was great”) or criticism (“you were wrong again”). Instead, provide specific, objective information on a particular task that your colleague can use to either build on their strengths or identify strategies for improvement.
  • Provide both positive and negative feedback (when necessary), with a focus on the positive. Positive communication correlates with higher worker engagement.
  • Focus on tasks, actions and objective events rather than subjective items (e.g., personality traits). 
  • Plan what you’re going to say and try not to deviate from this content.
  • Give feedback promptly — as soon after the event as possible.
  • Give feedback one-on-one.
  • Encourage self-reflection by asking open-ended questions your colleague can reflect on after the feedback is given (e.g., “How do you think the patient felt? What makes you think that?”)
  • Be aware of nonverbal cues such as your body language, posture and tone of voice. Try to make eye contact and look relaxed (e.g., keep your arms uncrossed) to signal openness and warmth.

Conducting a formal assessment of an incident:
If you need to have a more structured discussion around a specific incident or inappropriate behaviour, the meeting should follow the format of a performance appraisal or assessment. Here are some guidelines:

  • Always be respectful — thank your colleague for participating. 
  • Lay out the rules of engagement: you’ll speak first, then your colleague can respond. Get their agreement before proceeding. 
  • Clearly explain the purpose and goals of the meeting. 
  • Acknowledge your colleague’s worth and positive attributes. 
  • Review the written narrative of case facts. 
  • Stick as closely as possible to the points you prepared ahead of time. 
  • Speak slowly and carefully. 
  • Refocus the discussion if your colleague tries to divert the issue. Offer to discuss those matters at a separate meeting. 
  • Stop and repeat information regularly to prevent misunderstandings. Paraphrase and ask your colleague to repeat what they understand from your statements.
  • Conclude with acknowledgement of your confidence in your colleague’s good intentions and your expectation of cooperation for improved conduct in the future.

Adapted from Managing disruptive behavior in the healthcare workplace: Guidance document by the College of Physicians & Surgeons of Alberta.

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