All right. Welcome back. So, we talk, we're now going to talk about why feedback is difficult to do. I hope that you all have thought about it and have some good sense of this. Let me tell you why I think it may be difficult to do. So the first one is the usual excuse. I'm too busy. I don't have time. I can't do this. We need to get over this, right? We need to find the time. We need to make the time to do it. It may just be a minute or two. It may be 30 seconds, but we need to make sure that we provide the information to our learners so that they can improve and that being too busy is probably not a reasonable excuse. If we build it into our usual day, it will actually be better and be part of our process. I'm an emergency medicine physician and what I do is at the beginning of the shift, what I'll say to the learner that I'm working with is, what are you working on? And they'll tell me, I'm working on flow, I'm working on medical decision-making, I'm working on communication. And then what I do is throughout the shift, I will watch what they're doing so that I know what they're interested in and what areas to provide feedback. I may provide divect, directive feedback as we go through the shift, but each learner knows that about an hour before the shift as we start to wrap things up, I actually take some time and say, okay, let's do feedback. And that's how I place it in my busy day. If you get very intentional about it, it becomes a ritual or a process or a habit. Then you'll be much more likely to provide feedback. Don't use the excuse of I'm too busy. The next thing that, that makes feedback difficult is that it's based on personal observation and we all have a sense of that maybe our observation is not correct. Or maybe we're not ob, observing correctly. Or maybe our interpretation of that observation is not correct. And so, we have this kind of hesitancy to provide that information because we don't really know whether or not we're doing it appropriately or whether or not our response is right. And so, because it's based on personal observation, we discredit our thoughts. It's important that we do still provide that feedback. I'll often couch it in terms of this is the way I choose to practice or I observed you doing, but we need to provide feedback regardless of the fact that it may not be absolutely objective and that it is based on our own personal opinion. The next thing is we have a lack of knowledge or ability. We aren't really sure how to provide feedback or what is the right method or what's going to help the learner improve. And so, I'm hoping that by giving you the form steps to feedback that you will feel more comfortable in providing that feedback. The next thing is, I think we're concerned about poor rapport. There is this concern that if we provide negative feedback to a learner, that they will not like us, that they may evaluate us poorly, that they're going to think differently of us. And so, we're afraid of that, that poor rapport causing problems and so we kind of avoid providing feedback during the time, but it is really important that we do it regardless, that we ignore this fear of poor rapport. And, in fact, use the process of building feedback to build a rapport with our learners. Next, the reason that we often don't provide feedback is we have this fear of not being listened to. That if I, if I give some information, they're not going to listen to me. They're going to judge me poorly. They don't believe what I have to say and that they won't acknowledge that my observations may be correct. We, in some ways, need to just kind of work our way through this. We're going to talk about ways in which to establish a rapport with the learner so that hopefully they will listen to what we have to say. I think the next thing is that we're concerned about negative consequences. I worked at a place where, in fact, our resident evaluations of our performance mattered in terms of what kind of incentive we get. There may be negative consequences in promotion if a learner writes something negative about us, if our faculty see that we're not getting promoted in the right way. Or our chairman actually stops and us and says, well, what about this comment? And so, I think we do have the fear of negative consequences. To get over that, I think it's important to establish a relationship with the learners so that they know that you're doing this based on a commitment to them and not based on a punitive or mean purpose in doing it. And so, we need to go ahead and provide feedback regardless of the negative consequences, but we can ameliorate these consequences by being relatively effective in the feedback that we are providing. The next thing that I think makes it difficult is that there's dis, different perspectives. The resident may think that they are doing the right thing, but we don't necessarily think that they're doing the right thing. For example, one of the re, one of my residents recently turned to a nurse and kind of snipped at her about what the nurse was asking. And when I said something to her and said, you know, I'm concerned about this behavior. Why did you snip at her? And she said, well, you know, the nurse really came up and asked you the question and you deferred the question to me. But she wanted to hear it from you, the attending, and I knew that she wasn't going to listen to me. In that case, I didn't really understand her perspective. I thought I was giving her autonomy and responsibility by asking the nurse to go to the resident rather than to me. And I didn't realize that it actually affected the relationship between the nurse and the resident. So keep in mind that we each have very different perspectives of what's going on. So it's really important before we provide feedback that we understand the perspective of the learner so that we can take that into account when we are providing that feedback. And as we talked about before, providing feedback is one of the difficulties. Faculty think that they do it all the time and residents think that they don't do it commonly. So we need to make sure that we're it, addressing this disconnect, that the residents feel that they're getting feedback while the faculty feel like they are providing it. The final difficulty that we're going to talk about is the culture of medicine. The culture tends to be relatively hierarchical. The attending is above the resident, which is above the student. And this hierarchy can both help and impede the provision of feedback. In some ways, it makes us credible because we are above in the hierarchy, but in other ways, it makes us less credible because the resident will feel like they don't understand where we're coming from. So I think when we provide feedback, we need to be very intentional and thoughtful about this hierarchy. I think that learners will learn better if they have a sense that we understand their perspective and more, are on their level, as opposed to being a very top-down hierarchy. So when you provide feedback, I want you to stop and think about the hierarchy and try to think about being in their perspective so that they can understand and believe you as credible for the feedback that you provide. In this next segment, we're going to watch some videos. We're going to look at what was done well and what can be improved, and we're going to provide discussion about those. I'll see you when you get back.