I’ve only had one “real” annual review–from before med school, when I worked for a consulting firm. There was a self-evaluation to fill out, and then I met with my boss, and he told me I was doing fine, which basically consisted of showing up on time and being enthusiastic. On the one hand, really, I was 23 and in an entry-level position. Still, it was not a terribly useful exercise except as a gateway to my 3% raise. Which is pretty much the vibe I get, from my husband and friends with corporate jobs, and from The Office.
In medical training, we instead get feedback. Both as a student and now in residency, we’re supposed to get some kind of feedback at the end of every rotation. This has also been somewhat hit or miss. For one thing, like the article suggests, people tend to think you’re doing a good job if they like you. This was most noticeable to me with certain male attendings who would banter about cars or what have you with my male counterparts, but it’s not a gender thing per say. Medicine tends to attract a lot of type A people who have strong interests and hobbies, and like to talk about them. I remember, for example, being stuck in a conversation between an attending and resident about Nantucket, and how things have changed over the years with all the new money buying up property. And let me just say that I had very little to add to that conversation.
Anyway feedback. So besides whether you bond with the person evaluating you, the other problem with medicine is most of how you spend your time is not observed. There is a move towards watching trainees interact with patients–some of my med school rotations had these index cards we had to get signed off, for example–and the good attendings and residents will let you do some of the talking. But for the most part, even as an intern, most of my H&Ps tend to be with me watching the resident do the interview, which I can guarantee doesn’t add much. So you get evaluated on what they can see–how you present a new patient, how you outline a plan, and, often, how you respond when pimped–which, for those of us who are less verbally agile spur of the moment, does not necessarily correspond to the extent of your medical knowledge.
Not that I’m complaining. I did well during my clinical rotations as a student, so I clearly wasn’t harmed by the whole thing. But neither have I felt like I’ve gotten much feedback that’s been helpful. What I’ve learned has mostly come from: i. from attendings who teach as they discuss the case; ii. from watching really good attendings and residents interact with patients; iii. from watching not very good attendings and residents interact with patients (ie what not to do); iv. from reading, conferences, and the like. Usually the constructive criticism I get falls under the category of “read more”, which is…not that helpful when you’re already tired and overworked. For one, frequently I got that feedback when I hadn’t encountered something yet in training–like starting my OBGYN rotation, when I was told that “I didn’t know as much as would be expected by this time in the year.” Contrast that to one helpful piece of advice as a student, when my resident told me to read the Step 1 and Step 2 review book topics that related to my patients.
What would be helpful? There are a lot of resources out there. Good feedback is frequent, immediately related to something that happened ie “teachable moments”, and gives suggestions for how to act differently next time. Basically, acting as a coach. Atul Gawande wrote a New Yorker article about getting someone to coach him once he’d finished training, as an attending. And that, in spades, is what feedback during medical training would ideally be. And, for that matter, for jobs in general.