Difficult conversations: How to provide feedback to an attending physician

By: Enam Josan, MD

August 25, 2022

This post is part of our Life as a Fellow blog post series, which features “fellow life lessons” from current trainees in leadership with CHEST.

Feedback can be described as “information describing performance in a given activity that is intended to guide future performance in that same or related activity.” The process of feedback is a critical part of medical education, as it improves learning and performance. However, it can feel uncomfortable at times, especially when the feedback is perceived as “negative.” Feedback can be further complicated when feedback is directed toward someone in a position of power.

Entering fellowship, I knew that there would be situations where I would have to give tough, constructive feedback to medical students, interns, and residents based on my observations of their performance. I was comfortable with this dynamic as I had spent the prior year as a chief resident doing such on a daily basis. However, early into my fellowship, I encountered a situation where the learning climate was negatively impacted by the attending physician. I struggled with this dilemma because I wanted to protect the education of my team but also did not want to damage the professional relationship that I had built with my attending physician, all while being a new fellow. I was scouring the internet looking for resources to help solve my quandary when I had a sudden realization that we are all learners despite our experience and accolades.

Difficult conversations are often avoided because they are typically emotionally charged and high stakes, which can lead to some very tense and uncomfortable situations. In order to prevent derailing my entire fellowship, I knew I just had to lay some groundwork to help facilitate this difficult conversation.

• Set the conversational goal: Setting the conversational goal is the most crucial step entering into an emotionally charged conversation, as it keeps you focused on the task at hand. Your conversational goal should be clear in order to convey your concerns to the other party. You should also think about things to avoid in the conversation, which will help deescalate the situation.
• Listen: This may be easier said than done; however, listening to the other party’s opinions will help keep them safe and invested in the conversation. Your listening should be genuine, as conversations often break down because one party does not feel like they are being heard.
• Take action: The hardest part outside of starting the conversation may be trying to resolve the conflict when emotions may be at their highest. It is important to share the facts and your observations to keep the conversation objective. Be sure to allow each party to offer their own solution to the conflict as this allows for a shared mental model.

With these tenets in mind, I sat down with my attending physician and had an open, honest conversation about my observations. As it turned out, they were not even aware of their impact on the learning climate and were very appreciative of the feedback. This difficult conversation allowed us to learn from each other and strengthen our professional relationship. We should all be reminded that we are all still learners despite our level of training and experience and that feedback should go both ways.

Enam Josan, MD

Enam Josan, MD, completed his interventional pulmonology fellowship at The Ohio State University Hospital in Columbus, Ohio. He previously served as a member of the Trainee Work Croup at CHEST. His clinical interests include therapeutic bronchoscopy, management of lung cancer, and medical critical care.