Taking the Fear out of Feedback

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Something had to change. Students were going crazy. Lessons were not being learned. Mild-mannered professors were getting evaluations like “Dr. X should never be allowed to teach first-year dental students again.” And all because of the teachers were providing feedback.

It’s funny. Anyone who knows anything about feedback knows that it is the key to getting better at pretty much any subject you can name. Without a way of knowing what mistakes you’re making and what sorts of things you can tweak to improve, how are you ever going to make progress toward your goals? And if you’re just getting started in an area, you don’t know enough to provide your own feedback—you need someone who is already highly skilled and knowledgeable in that area to point out where you fall short and what you need to work on. But when I spoke with Jan Mitchell, as associate professor at the Dental College of Georgia, she opened my eyes to a side of feedback that I had never thought about before.

Jan Mitchell

Feedback is crucial in dental school, Dr. Mitchell told me, since a large part of the curriculum is devoted to teaching specific dental skills, such as how to properly “drill a cavity” in preparation for a filling. And it takes a lot of feedback before students really get the skills they need to become proper dentists.

One exercise that Dr. Mitchell described to me calls for students to reproduce the structure of a specific tooth in wax just as if they were creating a crown for a tooth in a person’s mouth. Because the crown has to fit properly relative to the other teeth in the mouth, its precise shape is crucial. It is important to get the space between the teeth just right, for example. But when the dental students first try it, they discover how difficult it is. “They’re very proud of their first try,” Dr. Mitchell said, “but they miss. It’s often subtle stuff. They have to do it, screw it up, get corrected before they can see the crucial contours. That takes a lot of feedback.”

Unfortunately, many of the students do not take well to the sort of feedback they get in dental school. In general, Dr. Mitchell noted, dental students did well in their undergraduate career. They got good grades, and they scored well on tests, or else they wouldn’t have been admitted to dental school. In short, most of the feedback they received as undergraduates was positive. They are high-performing students, which is certainly desirable, but the flip side of this is that their self-worth and self-image are often closely tied to the feedback they receive—and they may not respond well when they receive feedback that is not all positive.

Furthermore, the main feedback these students received as undergraduates came in the form of grades received on tests or assignments. They seldom, if ever, had the experience of someone observing as they performed and pointing out in real time what they were doing wrong.

For some of the students, none of this matters. Once in dental school, they appreciate the feedback they get from their instructors. They’re happy to have someone at their elbow constantly, watching them and telling them when they’re not doing something right.

Others—many others, Dr. Mitchell said—do not do so well. Regularly hearing what they are doing wrong threatens them, throws them off their game, and leads them to conclude that their teachers are mean and heartless. Resenting the feedback, they find it difficult to learn from it.

To get the dental students more comfortable with receiving feedback, Dr. Mitchell worked with Ralph A. Gillies, a psychologist at the Medical College of Georgia, to develop a half-day seminar that first-year students are given during their orientation week. The seminar is designed to do two things: explain the importance of feedback and prepare the students for how they may respond emotionally when they get feedback from the dental school professors.

I don’t know how widespread the problem is that the dental school faculty faced—students who are uncomfortable with feedback—but I suspect that it is not uncommon. Criticism never feels good, and feedback that consists mostly of pointing out what you’re doing wrong can seem awfully close to criticism. So it’s worth examining how Drs. Mitchell and Gillies tackled the issue.

To help the students understand the purpose of feedback, the two introduced the concept of deliberate practice and explained the role of feedback in deliberate practice—i.e., to point out mistakes and weaknesses (along with strengths, of course) so that the students know what needs to be improved on. This part of the lesson was delivered by having the students read an article, “Feedback in Clinical Medical Education,” and listen to a 20-minute lecture. A key point of emphasis was that nobody masters dental skills without a lot of practice (with feedback). There are no “naturals.”

Having explained the importance of feedback, the seminar instructors began to tackle the emotional aspects of feedback. They split up the students into small groups to talk about how it feels to get face-to-face feedback and how that differs from the less personal, more distant feedback that comes from receiving a grade. The dental students also heard about a study about how medical students rated two types of professors—those who just praised the students versus those who had given the students the sort of specific, on-point feedback that is necessary in deliberate practice and that had improved their performance. The medical students rated the praising professors more highly than those who had given them feedback they could actually use. The goal of all of this was to get the dental students to think about how they themselves react to feedback in order to recognize that they will have to deal with feedback-induced discomfort if they wish to improve.

Dental class with origami crowns

After that the students, still in their groups, are given an exercise designed to get them thinking about internally grading their own performance as well as to teach them to be more comfortable getting feedback from others, including their peers. The students are asked to each make an origami crown by following a set of printed directions. Once they are finished, they each assess their own project as well as that of a peer with a rubric similar to the ones used in dental school.

As Dr. Mitchell explained it in an article* on the American Dental Education Association’s website, “This exercise helps students see that practice with rubrics will develop the internal judgment needed to practice independently. If they can articulate their own strengths and weaknesses first, then when we come around, they’ve already gone through the first steps. They’ve prepared themselves.”

Furthermore, hearing critiques from the others in the group helps the students get comfortable with hearing suggestions and criticism from peers. As Dr. Mitchell told the website, “Students need to get over the idea that they deserve, or should even desire, privacy in practice. As medical professionals, they must be willing to seek and receive feedback from their colleagues without feeling stressed about it, and our peer review exercises are the beginning of their professional responsibility for peer review.”

The seminar has proved very successful in preparing first-year dental students for feedback, Dr. Mitchell said. The Dental College of Georgia has done the seminar for four years now (i.e., as of July 2017), and both the students and the faculty like it. In particular, the faculty report that the students seem less defensive in class when they receive feedback, and they are not complaining about classroom feedback nearly as much in course evaluations.

It is just one dental school’s experience, but the results would seem to tell us that it is worth taking the time to prepare people for feedback—in particular, explaining the importance of feedback—any time they will be encountering a feedback-intensive program or course.

 

*Those who are interested can find the article mentioned above at http://www.adea.org/Blog.aspx?id=36159&blogid=20741.

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