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maintaining that skill over a career require physicians to be lifelong self-motivated
learners, but lack of adequate expert guidance will foster education that is inefficient
at best and develops harmful improper patterns at worst. To provide the most effi-
cient and effective guidance in the operating room setting requires teaching faculty
to overcome the unique challenges of operating room education so that residents
and students can make timely measurable improvement in both technical and non-
technical clinical operative skills.
Feedback
To foster resident development, faculty must move beyond simply evaluating an
operative performance and provide the resident with feedback that will help him or
her improve. Although the precise words used to describe what we are doing when
we give feedback may change, this is not a matter of mere semantics. There are
important differences between evaluating a person and providing them with feed-
back. Providing good feedback to residents will help both faculty and residents get
the most of their educational experience in the operating room, and the importance
of feedback to both faculty and residents has previously been demonstrated [ 23 , 24 ].
Ende does an excellent job of outlining exactly why feedback is so important to
medical training and how we can draw on lessons learned from medical training and
other disciplines to provide good-quality feedback [ 23 ]. He first helps us to under-
stand the importance of feedback by explaining the consequences of inadequate or
ineffective feedback. When a learner such as a medical student or resident enters a
new environment, they are seeking feedback, and when this is not given, they
develop their own internal system of validation. In the case of residents, this internal
validation system tends to develop along with an increasing sense of their own com-
petence. As time goes on, they become increasingly resistant to outside criticism
which may continue on after graduation from residency [ 25 ]. Without a model of
constructive feedback, they do not seek out or respond to even well-intentioned
outside evaluations of their performance. Perhaps this is part of the explanation for
the limited use of third-party coaching by practicing surgeons despite its ubiquitous
presence in other fields such as music or athletics. In the absence of a better model,
they may fill in the gap and see themselves as their own best judges. The lack of
quality feedback has previously been demonstrated in surveys of residents with only
8% being highly satisfied with the feedback they receive and 80% receiving no
feedback [ 26 ]. Correspondingly faculty frequently report learning how to give
effective feedback as one of their greatest needs [ 24 ].
To understand how to give effective feedback, it is helpful to first define it and
distinguish it from evaluation. Feedback uses information gleaned about a system
and reinserts that information back into the system and in the context of education
or learning has as its goal, the improvement of the learner. It is important to keep
this ultimate goal of improvement in mind, particularly when trying to change
human behavior. There are many ways that we can provide a learner with informa-
tion about a performance or offer guidance for improvement that may not be
M. Mirza and J.F. Koenig