I am going to ask you to do something, and I hope you’ll play along. Think back on your week. Did anyone tell you that you did something well or that you could tweak the way you did something just a bit? Did anyone pull you aside to say they would have communicated that diagnosis or performed an exam maneuver differently? I hope that you said “yes.” Good medicine depends on feedback.
Feedback is a critical learning tool in medical education. Receiving feedback effectively builds rapport between the teacher and learner, helps the learner get the most out of the feedback provided, and, ultimately, improves patient care. Unfortunately, receiving feedback can cause significant apprehension, especially when our brains are subjected to an “amygdala hijack.” The amygdala regulates fear and anxiety by processing sensory input to learn what is dangerous. When we encounter a recognizably dangerous scenario, including perceived threats to identity such as constructive feedback, the amygdala triggers a fear response, sometimes going so far as to hijack our ability to respond appropriately to the threat. Based on previous experience, it overrides rational thought to initiate a fight-or-flight response, symptoms of which might include a rapid heartbeat, sweaty palms, dilated pupils, and the inability to think clearly.
Imagine the following scenario.
A colleague, who was charting nearby while Dr. Riser was conducting rounds with her students, approaches her at the end of the morning to offer feedback. Dr. Riser welcomes the feedback because this person is admired for their teaching skills but is surprised when they share that they think she could have done a better job including all the learners in the discussion. She keeps an open mind in the moment, even thanking the colleague for their thoughts. However, over the next few hours, it starts to sink in how demoralizing this feedback feels. Dr. Riser’s colleague did not have the full context—that she had been working on drawing out quieter students. She recognizes that they provided one piece of actionable advice that she will try out tomorrow, but her mind keeps going back to how unfair it was to give that feedback without providing an opportunity to share her side of the story.
What might be your initial reaction to this feedback? For me, based on prior experience, it would probably be a heavy drop in my gut followed by a few hours of frustration. Eventually, my mind would regain composure, and I’d start to think more clearly about the best way to handle the situation.
Having a model to apply in these cases helps feedback recipients get to that clear-thinking stage more quickly. At Stanford School of Medicine Teaching and Mentoring Academy, we developed and teach the “ARISE to Receive Feedback” model. ARISE is an acronym that stands for Ask, Receive, Interpret, Set next steps, and Express gratitude.
A – Ask
In the ASK step, the receiver takes the initiative. Ask yourself what kind of help you need and whom you need it from, then ASK for feedback. With a growth mindset, struggling with a skill or concept is a challenge but not a dealbreaker. We grow by stretching outside our comfort zone and asking for feedback from multiple sources.
Having identified a goal, Dr. Riser could have sought input from her colleagues or students. For example, “I am working on bringing some of my quieter students into the discussion. Do you have any best practices for how to do that?”
R – Receive
Feedback is a gift, and giving it is hard. Actively listening as you RECEIVE it shows respect to the giver while allowing you to take it all in. Note your immediate reaction. Do you feel angry? Sad? Defensive? Once you identify how you feel, you can choose your next steps rather than proceed on autopilot. You can actively select a mindset of curiosity. Your instinct may be to defend yourself. That option is still on the table, but first ask questions to make sure you and the giver are on the same page about what’s been said.
When Dr. Riser heard the feedback, she was understandably taken aback. That reaction is an opportunity to seek more clarity from the feedback giver. For example, “That’s interesting because I have been working on drawing out my students. Can you tell me more about what you observed?”
I – Interpret
This step is so important and so easily skipped. Rather than responding right away, give yourself time to absorb and INTERPRET the feedback. While reflecting, take the view that you are a complex person who will sometimes make mistakes and that there will be feedback along your journey.
Dr. Riser continued thinking about the feedback. It might feel like what has been said is entirely wrong, but it’s worth asking, “What are the pearls that I can get from this?”
S – Set next steps
Finally. You have heard the feedback, you have thought about it, and now you get to decide how to use it. Actively SET and maybe even write down your next steps. And, as you are developing skills to hear feedback, reflect on how you received the feedback. What went well? What could have gone better?
Dr. Riser found some actionable advice. She might also want to consider her reaction to the feedback. “Wow. That hit me really hard. I distorted the story into thinking that this meant I was a terrible teacher. Next time, I will get more clarity on what the feedback really means.”
E – Express gratitude
It is almost as hard to give feedback as it is to get feedback, so ideally, you thank the person for their thoughts. Like any gift, feedback is yours to do with what you like: keep it, exchange it, or return it. Dr. Riser might choose between:
- Keep it: “Thank you for that helpful perspective. I will try that out tomorrow.”
- Exchange it: “Thanks for that feedback. I’m also working on avoiding digressions. As an experienced teacher, do you have any best practices for that?”
- Return it: “I appreciate your perspective. They may have seemed quiet but are speaking up way more than last week.”
Think back to the feedback you received this week. How would that moment have gone differently if you applied the ARISE model? This skill takes a lifetime to master. We won’t get it right every time, but having this tool on hand provides a structure to fall back on in the moments when we are thrown off by someone’s input.
Alicia DiGiammarino is a health educator.
