Feedback

Feedback is incredibly central to learning. I do not mean the kind of feedback that program directors want to institute. They want us to sit down with attendings at the end of each month to discuss what we've done well and what we can improve. Attendings give constructive criticism on presentations, notes, and patient interactions. Certainly such discussions can be important, but I never got too much out of them, and indeed, when I try to give such feedback to medical students, I'm unsure how much I contribute to their education. Of course, this may be because we don't have great formal training on giving and receiving feedback, but that's a different point.

No - the feedback I find important - is that after a difficult call night when our actions, interpretations, and interventions are put to scrutiny. Overnight on call, I struggle with various problems and do my best to address them. But all that is laid open the next day when the rest of the team, the attendings, the consulting services look at what I did and either praise or criticize me. Last call in the ICU, we had a post-operative gentleman whose urine output had trickled off. In sending lab studies and looking at the clinical picture, I felt that he was dehydrated and underresuscitated in the operating room. I kept chasing after the urine output by giving him IV fluids. In the light of morning, the team and the surgery service looked at our overnight actions and the consensus overwhelmingly was that I gave too much fluid. Now, the patient did not come into harm - he was otherwise fine, and we got extra fluid off by diuresis - but that sort of feedback - standing up in front of rounds and saying that I gave 4L and coming under fire for that - made an indelible impression on me. That is how we learn as residents and house officers. And I worry a little that as medicine becomes shift work due to new work hour restrictions, this sort of education may become less and less important.