Perceived Identity and the Art of Feedback

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise. 

Dr. Tony Tizzano:

Hello. Welcome to today's episode of MedEd Thread, an Education Institute podcast exploring the role of perceived identity and the importance of dialogue and feedback conversations at Cleveland Clinics Lerner College of Medicine of Case Western Reserve University. I'm your host, Dr. Tony Tizzano, director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to have Dr. Kim Gifford, director of Professional Identity Formation at Case Western Reserve University and associate director of Cleveland Clinic's Pediatric Residency Program along with Dr. Tim Gilligan the diversity, equity and inclusion officer for Graduate Medical Education and vice chair for education at Cleveland Clinic's Taussig Cancer Institute here to join us. Kim and Tim, welcome to the podcast. 

Dr. Tim Gilligan:

Thank you. It's good to be here. 

Dr. Kim Gifford:

Thank you. 

Dr. Tony Tizzano:

So to get us started if each of you could tell us a little bit about yourselves what brought you to Cleveland and Cleveland Clinic, what your roles are here to give us a sense of identity. 

Dr. Kim Gifford:

Sure. Happy to share a little bit about my journey. So I grew up in a lower income household, so that drove a lot of my earlier interests and educational equity and I certainly didn't have as many, you know, role models and helpers, and the medical field as some of my peers. And then now I'm a primary care pediatrician and I serve a lot of patients living in poverty. So I like to combine that view of educational and health equity together. 

And so while we're working on all these systems, level solutions, one of my own passions is coaching. I, I love to work individually with learners, with kids that are experiencing a lot of these issues and to help them to explore their identities and to leverage the strength that they have from those multifaceted identities. And that's how I became interested in all of this work. 

I think it infuses into all of my educational roles and my clinical roles, and thinking about how identity fits into feedback for the topic of today's conversation. 

Dr. Tony Tizzano:

That's fabulous. And I know in your role in the art and practice of medicine course, you do just that.

Dr. Kim Gifford:

(laughing) 

Dr. Tony Tizzano:

You bring a lot of that to the table. Tim, what about you? 

Dr. Tim Gilligan:

I have a very different background. I had a lot of privilege growing up. I'm a fourth-generation physician and had a relatively easy path forward as a result of that. I had wonderful teachers in high school and college, and medical school who gave me phenomenal feedback. And I feel very aware of how specific moments of feedback really resulted in specific changes that helped me improve and do better going forward. And I think one of the things that motivates me is I wish everyone had the opportunities that I've had. And I think if we pay more attention to the quality of teaching and feedback we can help people reach their potential better. 

My other big passion is healthcare communication. I have been teaching healthcare communication for about 12 years now and I think when we think about feedback and also when we think about identities and diversity, uh, these are all challenging conversations. And if we're thoughtful about how we choose our words and how we structure the conversation we can be more successful at achieving the outcomes that we want to achieve. 

Dr. Tony Tizzano:

Fabulous. So two very different backgrounds. And, Tim I, you know, having listened to you many times in the areas of diversity, equity, inclusion, we all admire the work you do. So despite coming from that, quote, unquote, privileged background, you bring so much to the table. So in today's segment, we hope to focus on how to enhance feedback dialogues through awareness of identity, particularly when there are differences in identity whether they be generational or gender related for example that may either positively or negatively impact conversation. So with that being said, can you help us frame this topic a bit? 

Dr. Kim Gifford:

Sure. So I think on The Superficial level when we think about feedback, it seems like it's a conversation between two people because it is. But there's really a lot more behind that conversation that's happening. That conversation is happening in a setting, in a context that's within an institution and within society. And all of those influences impact both parties in that conversation. 

It impacts the way they view the situation that they're discussing feedback about and it impacts the way they deliver the feedback about that situation, and it also impacts the receiver of the feedback and the interpretations that they make based on how that feedback is delivered. In that situation, they're drawing on their past experiences too that come into the moment and impact the reactions and the way that that the emotions come to the surface, and how they interpret the messages. 

And so little conversation is in the setting of all of these bigger pieces. And, and not that we think about that every moment in feedback but it's important to understand all of the factors that come into play in that feedback dialogue. 

Dr. Tony Tizzano:

Excellent, Tim, what would you add? 

Dr. Tim Gilligan:

I think it's relevant to a sort of a major shift I think that's taken place in medical education the past couple of decades that I think there was a time that the teaching and the feedback was structured in a way that was most convenient for the instructor and the professor. So we taught the way that was easiest to teach and we gave feedback in the way that was easiest for us to give feedback. And I think we've really benefited from people who are experts in education and learning to really change medical education so that it's more responsive to what do we know about what actually helps people to learn and can we structure our courses and our feedback in a way that's most beneficial to the learner rather than most convenient for the teacher? 

And I, I think that's a big piece of the feedback conversation is that there are skills you can learn. There are better ways to have the conversation. And if the goal is to vent and get some negative feedback off your chest, that's one thing, but that's probably not very helpful to the learner. If the goal is for the learner to do better next time then we have to be thoughtful about what kind of a conversation actually helps someone do better next time? 

And we have to take into account that they're emotional and psychological factors here. We're not simple rational beings where you just tell me the 10 things I did wrong and then I'll never do them wrong again. That's not how people work and there's more subtlety to it than that. More humanity to it. 

Dr. Tony Tizzano:

That's for, that's for sure. Where does hierarchy between the giver, receiver, vice versa, where does that fit in? 

Dr. Tim Gilligan:

Well, I think it's huge and different people respond to hierarchy in different ways. Some people are very differential to it, some people are resistant to it. And hierarchy also plays out differently based on identity because identities have a hierarchy and if you're the only person who looks like you in a room is going to feel different than if everyone looks like you in the room. And so I think that's the hierarchy piece gets at some of the identity challenges that if you're a, a doctor talking to a nurse, they can feel like there's a hierarchy there.

Dr. Tony Tizzano:

Sure.

Dr. Tim Gilligan:

If you're a man talking to a woman, it can feel like there's a hierarchy there. Not that there should be, but that in our culture some people have been treated in a more privileged way than others. And, and so being sensitive to that. Also, just differences in experience that my experiences and some ways are based on what my identities are and someone with different identities has had different experiences. If I assume that everyone is having the same experience as me I can't have as good a conversation with other people. 

Dr. Tony Tizzano:

Well said, well said. So, Kim, tell us tell us about your thoughts around dialogue in the feedback and the roles of the giver and the receiver? 

Dr. Kim Gifford:

And so as I mentioned earlier, feedback has to be a conversation. It's not one way. And in order to create that conversation, you have to draw on the concepts that Tim was just talking about now and thinking about where each person is seated and where they're coming from, and their perspectives. And the thing about feedback is that no one (laughs) actually has all of the information. You know, the person who's trying to be the giver in the, the feedback situation may have observations, insights. Sometimes they have some seniority. 

Maybe they're higher in that hierarchical framework. But they only have their end of that. What they don't know is what's maybe going on internally for the person they're trying to give feedback to, the, the receiver. In that situation, it's really important particularly referring back to hierarchy for the person who has that maybe hierarchical level to be able to be a good listener and to be a good respondent to what they're seeing in those situations, so that they can help let the person who's maybe the receiver be able to share where they're coming from, what they're feeling, what they're experiencing, what's actually the drivers of their behavior. 

And if the drivers of that behavior are not known, there's no way (laughs) you can use your feedback conversation to shift that. And so I think it's important that both parties are involved in that dialogue. And that it can be initiated very easily by someone who may be the receiver of feedback by becoming a seeker. And so by reaching out and saying what you want feedback about, it actually makes you be able to receive it in a more effective way. So I think the bottom line is that feedback can start from either side and it needs to be bidirectional throughout the dialogue.

Dr. Tony Tizzano:

Well put. And, you know, you mentioned receiving feedback. Well, sometimes I think, you know, we see courses all the time on how to give feedback, how to be a good mentor, an instructor what have you. But receiving it is just as important. How do we coach ourselves or think about ourselves in ways that we're more receptive to the feedback, good and bad that we get. So we look at it as an opportunity. 

Dr. Kim Gifford:

Yeah. I think there's definitely an art to being a good receiver. And when you're in the receiving role, sometimes that can be really hard to do if the feedback is unwanted and unsolicited. Sometimes it, it hits you hard and you can feel like you don't understand where it's coming from or, or what it means. I've been in a situation to coach a number of learners who have experienced a lot of bias in our society. And it's really hard sometimes to know what aspects of feedback they're receiving are based on their performance. (laughs)

Things that are based on, you know, how they look, how they act. What biases the, the giver might have. And so situations (laughs) it's really hard for them to be able to dissect out those pieces and feedback and need some, some help in the coaching kind of setting to guide through that and I think that's where the person who's delivering the feedback being aware of those pieces can help a lot. 

Dr. Tony Tizzano:

Tim, you made reference to identity. Could you help expand on the nuances around the role of identity and how sensitive it is as it pertains to conversations around feedback and learning? 

Dr. Tim Gilligan:

Well, I think the unfortunate fact is that identities affect our perception. They've been multiple studies showing that people with different races will receive different feedback for exactly the same performance. And our ability to accurately judge performance if it isn't anchored well to hard end points and concrete end points can be very, very sloppy. And I think that's one of the things that worries me most in terms of feedback across difference is, are we actually giving fair feedback? 

One of the clearest studies that showed this was, uh, actually in the legal world where they took a fake memo that they had pretend someone had written and it had a whole bunch of errors in it, spelling errors, grammar errors and they distributed it to law partners to evaluate the... The American Bar Association did this. And they said the race of the person that this is a young associate and they happened to mention he, he had the same name on each form, but some forms listed him as white and some forms listed him as black. 

And the partners found more spelling errors if they were told it was a Black associate and they found more grammatical errors. And their feedback around the the white person was that he showed promise and the feedback around the black person was how did he get in here? And it was exactly the same memo. And so I think we tell ourselves that we're fair and we don't see color, but we actually do. 

And so in giving feedback, it's important for me in a teaching role as a supervising medical students or residents, whatever, to ask myself am I really judging this performance fairly. And I think it requires some humility to recognize that our perceptions are biased and our perceptions are subjective. And there are things we can do to overcome that but it's really very important to be fair. 

And I think that's one place where the dialogue that Kim is talking about is really important is that we don't have to do this all by ourselves. If we're talking to the other person and we're having a dialogue and we're listening to them and we're curious, then we can arrive at a better place together. We don't have to do it alone. I mean, another example I can give where it comes into it is sort of humiliating experience that I had was I was trying to give feedback to a female trainee ones and I was trying to figure out why she wasn't reaching what I saw as her potential to be outstanding, and she's doing a fine job. 

I totally overlooked the fact that she had a young baby at home was having to pump milk during noon conferences and when she went home at night, and that she had a challenge that none of her male classmates had and that I had never had. I've never had to miss a lecture because I had to go pump milk for my baby. And so if we're sensitive to how different identities can lead to different experiences and different realities, we can work in a way that I think is better for everyone. 

Dr. Tony Tizzano:

So how do we get better at that? You say, you know, we can take steps to be more insightful. You know, where do you start with that? 

Dr. Kim Gifford:

My favorite is the Implicit Association Test. And if anyone listening to this has not done it, you could just Google IAT and take these Implicit Association Tests that lets you know what's going on under the surface of your own mind. And when I did it for the first time, I was totally shocked to see my own feeling as a, you know, woman who overcame a lot of obstacles (laughing) growing up to see that I was actually biased toward male leadership. 

It shocked me to see that, but that's because that's what I experienced, that's what I saw. And so I internalize some of these lessons. So anyway, I think everyone should do all of the Implicit Association Tests to get a sense of what's going on in your mind. And then another important factor is taking time to spend time with people who are different than you in any way. Learn about sort of the way that they maybe think about things differently than you, to have some experiences that might be things you wouldn't ordinarily do, so that you can get to know some different perspectives. 

And then the last thing I'd say is just being curious, having an open mind asking questions whenever you see yourself having a judgment of any kind, ask what's behind that judgment so you can start to tease out why you might be thinking or, or jumping to the conclusion that you do. So I think those are a handful of things that can be helpful. 

Dr. Tony Tizzano:

Did you want to add to that, Tim? I see you ready to say something. 

Dr. Tim Gilligan:

Yeah, just another actually story from my own experience that brought to mind for me is I, I was the program director of the oncology fellowship for about 10 years. And there's not a lot of black medical students or residents who apply to go into oncology. It's, and... But we've had some in our program. And I had one who, who we brought in and one of the faculty came to me one day and said, "He's underperforming and the problem is he's an idiot." 

And in 10 years, that's the only time I've ever heard any of the faculty refer to as one of my fellows as an idiot. I was offended in part because I don't admit idiots into the program. But like that's not helpful feedback and actually turned out to be a false statement because what I realized is that he was with the wrong faculty person and I assigned him to a different faculty person. He ended up being one of the strongest fellows in our program. His test scores were among the top and his feedback was among the top. And he did really very well. 

Once we figured out how to get him with people who would actually give him useful feedback and help him reach his potential. But it was a real learning moment for me of like what his experience was because if I go into the room and I struggle, people say, "Oh, Tim, needs more help. Why is he struggling? He should be doing well. What can we do to help him?" And this kid the feedback he's getting is very negative and, and, and judgmental. And, and fortunately, you know, we had a cancer center director who is very sensitive to all of this and I think, you know, that ended up being a success story but it might not have situation. 

Dr. Tony Tizzano:

I could see that. You know, your point about inserting yourself, Kim, into situations which expose you to things that aren't common place for you, we... You know, coming from Western, Ohio which has a whopping diversity index of about 3%, you know, we really worked with our kids to fortunately insert ourselves into the college and have international students come to our home during holidays and so forth largely from India and Africa. 

And our kids developed a really very different. It was a palpable difference in the way they interacted with persons of color. And I think you can be proactive and perhaps make change. So earlier Kim you mentioned the importance of being sensitive, reflective, and considering where your own assessments around a conversation originate from. Can you kind of expand on that precept please? 

Dr. Kim Gifford:

Sure. Yeah, I think it goes back to some of the pieces we were talking about our own assumptions, biases, past experiences that we drawing on. So anytime we're observing, someone else's performance, as human beings, we're making judgments, inferences, about the why, or the what, or the how of what's going on in those situations. And we might be right. (laughing) We might be wrong, but we actually don't know until we enter into that dialogue with the learner. 

We know what we observed. We might be able to comment on the impact on a patient or a situation or whatnot, but we don't actually know if, you know, going back to Tim's example, is this an issue of knowledge? Is it, uh, is it an issue of lack of exposure to something? Is it an issue of language usage? Was somebody just nervous? Are they having a bad day? Did they have a bad family event (laughing) happen? So many other things that may be coming into play. 

And so if we come into a situation assuming that there's a problem with say knowledge and we try to fix it from a (laughing) knowledge standpoint we're so far away from what that learner actually needs that they, they're not even listening anymore. We're just [inaudible 00:18:31] and not saying things that are useful. And so being able to check in about say, "You know, here's what I observed." What did you observe? What was going on for you at the time? 

And we can actually much more quickly get to what the teaching point is there. What do they need to help learn and grow and move on from that experience with a good lesson for the future? 

Dr. Tony Tizzano:

Perfect. Yeah, it makes absolute sense. 

Dr. Tim Gilligan:

And I think that's a really important point because one of the things there that you can do is to be curious. And I think we often jump in thinking we know the answer, but we don't know the answer. And I think, you know, "I'm an expert in heart failure so I'm going to teach this person about heart failure." And I forget to think, "Well, that's great that I know all that stuff. What don't I know that I need to know?" And I, this, the diagnostic issue is really quickly, it's like we're jumping to treatment before we've actually made an accurate diagnosis. And we wouldn't think that's good medicine. It's also not good education. 

Dr. Tony Tizzano:

Yeah. I think maybe as physicians we have a tendency.

Dr. Kim Gifford:

(laughing) 

Dr. Tony Tizzano:

Patient starts to say something. We already [inaudible 00:19:28] we already have an idea of what we think this is going to be, but please let them stop. Explain everything that you wanted to say and then try to put two and two together. 

Dr. Tim Gilligan:

Well, if you think of like one of the good habits in medicine is I think this patient has heart failure what evidence do I have that it's not heart failure, that it's something else? We can say the same thing with the learner, like I think this student is struggling with knowledge. Is there evidence that it's actually a different problem or is there evidence that I need to have that I don't have yet that would help me understand it better? 

Dr. Tony Tizzano:

So you're talking about awareness. I really feel in all the these areas that we talk around these psychosocial aspects in medicine, it's how do you increase your awareness? How do you become sensitive and open-minded to thinking about other ideas around any topic that we, that we give consideration to? So Tim along those lines some of our listeners might be wondering in this approach in another example of political correctness, is that a thing that we have to be careful about where we become oversensitized? What are your thoughts? 

Dr. Tim Gilligan:

I, I actually think that's a really lazy term. And I think political correctness is sort of like an argument and a philosophy that's baked down into two words and it's... For me, it's sort of intellectually lazy. If someone is going to use that term, I'd like to know exactly what they mean by it. For me, the goal is for learners to learn, for their performance to improve. I would like to see the fellows in our oncology fellowship become better oncologists. 

I'd like to see them have better conversations with the patients make more accurate treatment plans, you know more about the drugs and the disease pieces that they're teaching and I'd like to give feedback in a way that helps them achieve that goal. The, the outcome is their improvement and their experience improves or it doesn't. The term political correctness doesn't help me with that. 

Dr. Tony Tizzano:

Well, I can see why you say that. 

Dr. Kim Gifford:

(laughing)

Dr. Tony Tizzano:

Kim, what do you think? 

Dr. Kim Gifford:

Yeah. I, I fully agree with everything that Tim said, you know, keeping your eyes on what, what your goals are and where you're trying to get to. I, I think, that the best way to do that, air quotes, political correctness thing i- is actually just to be o- open to listen, to respect the other person where they're coming from. And when we do all of those things, we, uh,  almost automatically do something that's comfortable to the learner, whether or not it would, you know, be the exact right word to say. Learners appreciate it. And, you know, anyone that we're in dialogue with appreciates when we meet them where they are and respect who they are. 

And when that's a feedback conversation that you're trying to have and trying to help them to grow into the future, as long as they feel that you're invested in them getting better that, you know, that they can do... If you're conveying that, you know, that, "You can do it. Here's the next step for you. Here's the way to get there having this kind of growth mindset," I think you'll automatically be giving feedback in, in an inclusive way and they'll feel like your partner rather than if you're, you know, doing Tim's (laughing) example of criticizing and tell... Let me just tell you everything you did wrong. That's actually not even feedback. That's really use. But if, if you can help them to see where they could get to and how they could take that path, I think you don't even have to think about this term of political correctness. 

Dr. Tony Tizzano:

That's very insightful. I, you know, I sit here and I listen to myself hosting these topics and realizing that I usually don't know a fraction of what the people who are my guests. And I think that's an advantage for me (laughs) because I'm, I'm like, "Oh, yes. It makes perfect sense. I don't have a preconceived notion of where it needs to go." Tim, you brought another word that I would like to just hear more about that I, I didn't really get and wrap my head around. And this is this autokinetic effect that you've mentioned in the past. And could you expand on what that means? 

Dr. Tim Gilligan:

Yeah. It's a, it's a great study. It came from someone's, I think, PhD thesis and I can't quote you the person's name unfortunately. I wish I could give them credit. But they did this really cool study where they... It turns out that if you take a human being you put them in a dark room and you shine a bright light on the wall, and it's perfectly still, and the person stares at the light, they will perceive the light to be moving. And I believe, my understanding is it has something to do with the fact that our eye muscles get tired and they start to move around, and we think the light is moving but it's not. 

What they did in this study was they took three people and they put them in the room and they all looked at the light, and then they all talked about how much the light had moved. And what they found was that over time the group... They have three people. The group of three people would arrive at a consensus of how much they thought the light had moved. But they... Individually, they had different estimates of how much. The light hadn't moved at all but each had individual estimates of how much.

They come to a consensus about how much they moved. And then he had them leave the room. And you bring them back one by one and what was interesting was that when they came back by themselves, they stuck with the group consensus rather than their own individual decision. And the interpretation of this was the way in which groups influenced how we perceive things, and how we perceive reality. So I thought the light moved a little but the group thought it moved more. 

So then I moved to their assessment of, "Oh, well, it moved more." And then when I go back by myself and I look at it, I now think it moved more that that contamination of group think carries forward even when I'm by myself. So I think the relevance of that for this is for us just to be cautious that if we think that a still light is moving, something as simple as that we can't get straight, then how many other mistakes are we making? Can we be humble about our ability to perceive? And the way in which biases creep in that we're not aware of, we can't be perfect but we can be humble and we can try to do better. And again, that for me is partly where the dialogue is so helpful is that if I talk to the other person with curiosity and I listen to them, then we can move together to a shared understanding in a more effective way than if I assume that all of my perceptions are accurate and correct. 

Dr. Tony Tizzano:

Humble is a great word. Kim, what other factors would you say shape the way we receive feedback? 

Dr. Kim Gifford:

Well, one thing that I think is really important, this is on both receiving and giving, is that in some ways what we're trying to do is take the person that may be receiving the feedback and bring them into the fold. (laughs) You know, if I'm a primary care pediatrician, I may have a, you know, student or a resident or whatnot in my clinic. And I'm trying to help them to learn the ropes of being a primary care practice or learning about that lens on healthcare. 

And so the more that I can sort of make them see the way that, that practice impacts health, the more that I can help them to be comfortable that they have the tools and the resources to do that, and the more that they can see themselves in that role, then the further, they'll be along in that path. And so if I'm going in- into it with criticism and telling them how they're out, they're not part of, you know, this group that I'm in, or I can come into it with support and encouragement and helping them to learn more to be part of the group of medicine. 

That second approach is really to me what we're trying to create in a feedback dial is bringing people along, bringing people into, you know, this space that we're in. And I think the more that we're able (laughs) to do that, the better the relationship (laughs) is, the more they're actually able to be helpful (laughs) in the setting that we're in, the better that we work together in the future. 

And so I like to think of that sort of empowering viewpoint helping to make people matter as they're going along. And when you feel (laughs) like you matter, this is the receiving end. Now, when you feel like you matter, it's so much easier to listen to feedback, to hear feedback, to be able to engage in the feedback dialogue. And when you think you're being criticized, you maybe get defensive, or you respond differently. So I think that both parties have a lot of control over that, but the way that we shape the environment ind that feedback dialogue makes a huge impact. 

Dr. Tony Tizzano:

I agree. We, we all want to be relevant in one way or another. I love this saying where, you know, at the end of the day people may forget the conversation, but they will always remember how you made them feel. So Tim, when we look at all these various precepts and we tried to bring it all together to be listened to, accepted, believed, and integrate all of this, you know, how do we do that? How do we try to bring that together? 

Dr. Tim Gilligan:

Yeah. I, I, I think it's a really important point. How do we get someone into a learning mindset, a growth mindset, a positive mindset? I think one of the great things that we have going for us in medical education is the number of hurdles people have had to jump over, to get into medical school means that we are working with a very self-motivated group of adults who are smart, who are hardworking, who really want to succeed. 

They've given up a lot to get to where they're trying to go. They're much easier paths in life than going to medical school and residency and fellowship. I think it's great. I'm not complaining, but it's a lot of sacrifice of weekends and evenings working and studying and stressing. They want to learn. So I think when we go in and we see see them underperforming, we can get lazy and think, "Oh my God, this is a lazy student who isn't doing their work or they're not trying hard enough." And I, they need a real kick in the rear end for me. 

And that's rarely the case. and often times if they're struggling, they're very embarrassed about it and they feel terrible about it and they, they're used to succeeding in getting A's and so when they're not it's this huge let down. They're well aware when they're underperforming and they hate underperforming. So what they need from us is not a reminder that they're underperforming, usually. There are exceptions to this, sure, but usually, what they need is some encouragement that we see how hard they're working, that we know that they want to succeed. 

Maybe what they're doing right now isn't working and they need a different strategy but we have an engaged motivated learner almost all the time. And if they're not doing well then something's wrong that needs to be fixed. And it's not that there's something wrong with them, it's that maybe they're studying wrong or maybe they have the wrong learning environment. But encouragement is really important 'cause I think if they come out of a feedback conversation feeling like we believe in them and we wouldn't have them in our program if we didn't think they were smart enough to succeed. 

And so we just need to figure out what it's going to take for them to do well. And we need to also remember what they're trying to do is really hard. And so if they're struggling that's actually a little bit normal 'cause it's normal to struggle at hard things. You just keep working at it and if they can come out of the conversation feeling encouraged that we believe in them, we have faith in them and they can do this, that's much more likely to lead to success than having them leave the conversation feeling like we're criticizing them. We think they're, something is wrong with them or they're not smart enough or things like that.

Dr. Tony Tizzano:

Yeah, well said. And I think struggling and willingness to struggle is really an important quality that I always admire when I see them going back to the drawing board, doing it again. The project didn't go the way I'd hoped. And, you know, shift gears and, and here we go. So for either of you, you know, what pearls can you leave us with for giving individuals more inclusive feedback? 

Dr. Kim Gifford:

I think the thing that's most important to me is that feedback is, is about a relationship. It's about having some kind of connection and trying to help each other actually forward. And so taking just a minute or a few, 30 seconds to make sure that you've built a little bit of rapport before jumping into whatever the topic is to make that connection. Number two, being sure that it's clear that the purpose of the feedback is to help them learn and grow and that you believe they can do it and come out successful in the other end. And then number three is making sure that you're understanding where their perspective is coming from so that it's a, it's a dialogue. 

And I think if we do those three things, we don't have to worry about like, "Did I say exactly the right word? And what might be their interpretation?" You don't need to know what might be their interpretation if you ask (laughs) or what might be their experience if you ask, and make it a safe space where they can truly share that. So, yeah, I'd go back to take time to build rapport, you know, ask questions, be curious and make it clear that you want to help them grow. 

Dr. Tony Tizzano:

Excellent. Tim, any thoughts from your end? 

Dr. Tim Gilligan:

I think those are great thoughts to end on. The only small thing I would add was to take us back where Kim started about the dialogue piece. Part of that dialogue is having a feedback conversation with the learner. It's great if I can get feedback from them on me as a teacher. What have I done that's been effective for you? What could I do better next time? 

Dr. Tony Tizzano:

Yeah, I always look forward to after any presentation that they have some kind of form to tell me how did I do. And you just make all these little nudges, and sometimes you have a little epiphany here and there too, that you really need to think about. So for both of you, is there anything I didn't ask that you feel it's important for our listeners to know? 

Dr. Tim Gilligan:

I think the delicate thing around this is there are times that it's important to talk about identity, and yet there are also times that it's not. And my goal in that is to create an environment in which it's safe for someone to talk about their identities if they choose to do so or if they want to do so. It's not my practice to routinely introduce it because it's not always relevant or it's not always something that feels safe to them or that they want to talk about. 

But I do think there are times that someone's experience is influenced by the color of their skin or their sexuality or their gender, and they're experiencing that. I would like them to feel that it's safe for them to talk about it. 

Dr. Tony Tizzano:

Yeah. And that's a tall order. If you come from the background of a privileged group, it's sometimes hard to, you know, set the stage where people feel psychologically safe, but it is so critically important. 

Dr. Kim Gifford:

I think the thing that I would add too is actually about sharing vulnerability particularly when you're in that giver role because that helps with the psychological safety. And sharing your own fallibility (laughs) and your own approach to growth mindset can really serve as role modeling and also shape how you hope that the feedback conversation and your educational relationship evolves over time. 

Dr. Tony Tizzano:

Well said. Well, thank you so much Kim and Tim. This has been a very thought-provoking podcast. To our listeners, thank you very much for joining and we look forward to you joining our next MedEd Thread podcast. Have a wonderful day. 

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread and please join us again soon.