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Difficult Feedback Made Easier

We know that you know that great feedback is specific, timely, and behavior-oriented, but giving good feedback isn’t always easy. You’ve probably heard about the feedback sandwich: positive feedback – followed by negative feedback – followed by positive feedback, but you know from personal experience that it’s not always appetizing and that the big message can sometimes get lost in vague flatteries. This week, we offer a 3-step solution to providing real feedback in a useful way that doesn’t feel super awkward. This technique is especially useful when the feedback isn't uniformly positive. 

1. Identify a behavior/decision.
2. Make a judgement of the situation and rationale.
3. Ask an open-ended follow-up question.

You may be surprised at what you learn when you deliver feedback this way. In many cases, the learner’s perspective (sometimes called the “frame” in debriefing literature) is not at all what you thought and the teachable aspect of the

case is divulged by the learner. 
Observe carefully for feedback opportunities and practice linking the steps together. We’ve included some examples so you get the idea. 


   “I noticed that you decided not to order a head CT for Mr. Smith. I’m concerned because his history of alcohol

   use and trauma increases his risk for ICH. Tell me about your thought process.”


   “I noticed that you haven’t re-evaluated or updated Ms. Jones. Re-evals are an important aspect of EM care.

   What got in the way?”


   “I saw you ordered an opiate and Zofran for the patient with headache. I’m worried either of those medications

   might actually make her headache worse. How did you select medications for her?”


   “I noticed that you were able to de-escalate Mr. Doe without having to resort to ketamine or a B52. That’s

   obviously helpful in terms of being able to assess him psychiatrically and expedite his care. What do you think                

   contributed to that outcome?”


PINNACLE TIP: Because feedback delivered in this way feels more like a conversation and less like a crap sandwich, learners may need you to signpost the feedback they’re being given. 

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