ARRS 2022 Abstracts


E1477. Providing Feedback to the Resistant Trainee
  1. Tzivya Weiss; Staten Island University Hospital
  2. Gary Whitman; MDAnderson
  3. Diana Lam; UW Medical Center Radiology and Imaging Services
  4. Christopher Straus; The University of Chicago
  5. David Sarkany; Staten Island University Hospital
The importance of formative versus summative learning or assessment has been increasingly recognized in medical education and is progressively centered on the giving and receiving of appropriate constructive feedback. Although there have been several notable articles that delineate when and how to escalate to remediation strategies for various deficiencies, there is no clear consensus on how to proceed when the recipient of seemingly appropriate constructive feedback proves adamantly resistant to the feedback provided. In this exhibit, we suggest a step-by-step approach detailing how to address resistance to appropriate constructive feedback in a student, employee, or other recipient, with the aim of obviating the need for official remediation or punitive action.

Educational Goals / Teaching Points
Step 1 is review and identify (review the feedback already given; identify obvious barriers). Step 2 is invite and validate (invite recipient reflection on the issue; express validation of the recipient’s viewpoint). Step 3 is respond and reframe (respond to newly identified barriers to feedback identified by the recipient; consider reframing feedback by separating the behavior from the recipient themselves; focus on the perceived or real impact of the specific behavior as the impetus for change; emphasize that the need for change does not mean that faculty/superiors/employers disapprove of the recipient or that the recipient is inherently deficient). Step 4 is summarize and agree (summarize to verify understanding of the current situation and what has been revealed or reframed after the above; agree on a single narrative that has been validated by both parties; seek agreement to try and make a small concrete change). Step 5 is negotiate and schedule (determine a realistic and short-term goal that will in some way change the impact of the negative behavior; record the plan and provide both parties with a record of what was chosen; schedule a follow-up meeting). Step 6 is review and debrief (review the outcome of the determined action plan; if there was success, discuss factors that aided in success, agree on continued or further incremental action and set up another follow-up meeting; if the intervention failed, proceed to step 7). Step 7 is feedback and retrial (determine if the failure was due to external factors or factors within the control of the recipient).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques

This exhibit provides a step-by-step approach to dealing with the resistant trainee. Only if a resident consistently lacks insight or fails to address the newly identified barrier despite shared planning of a viable method to do so should official remediation be considered.