Feedback as an Antidote for Depression

Hi everyone:

I was struck by an article published in last week’s Annals, suggesting that high-quality feedback mitigates depression in interns.¹ Maybe this result surprises you, given how stressed some people get about giving and receiving feedback. So let’s explore the findings.

It's well-known that medical training is a risk factor for depression. This is why we work so hard to promote wellness, offering access to mental health services,² connecting residents with faculty in the MAC program, creating color block communities, protecting golden weekends during ambulatory blocks and electives, decreasing the number of 28-hour calls, planning retreats and wellness events, promoting resident agency, and doing everything we can to ensure reasonable work hours. As The Annals study shows, these efforts work: interns are less depressed when they sleep more, work fewer hours, use mental health services, and, crucially, when they get high quality feedback.*

I’m not surprised that feedback mitigates depression. I remember my own insecurities as an intern. Every mistake I made seemed to expose my shortcomings. The fact that my colleagues were so brilliant reinforced my sense that I didn’t know enough and never would. My exterior may have conveyed competence and confidence, but that’s not how I felt inside. Although I didn’t realize it, I desperately needed feedback to redirect my self-flagellation towards ways to grow as a physician. I also needed feedback to reassure me I wasn’t alone in my self-doubt.³

This year, one of our residency’s major goals is to increase the quantity and quality of feedback.⁴ To accomplish this we’re asking residents to identify which faculty members and residents should provide written feedback after each rotation. So far, the efforts are paying off: since the summer, the number of evaluations returned within two weeks has risen 20%, though we’re still far from our goal of 100%. The quality of feedback is improving too, with many more narratives citing specific observations about performance as well as concrete suggestions for improvement. High quality evaluations like these are indispensable, and I’m grateful to the residents and faculty who put so much thought into what they write.

We should take it as a given that every resident in this program will succeed. By June, every intern will be ready to become a senior resident, every PGY2 will be ready to become a PGY3, and every PGY3 will be ready to graduate. But to get there, each of us needs to be prepared to give and receive feedback in the middle and at the end of each rotation- feedback that is thoughtful, encouraging, and constructive. Consistent, high quality feedback reassures and encourages us, while providing sign posts pointing to ways to grow. Let’s commit to completing this core responsibility, knowing that both our professional growth and mental health depend on it.

Enjoy your Sunday, everyone. It’s time for me to go for a hike!

Mark

*Although the study focused on faculty feedback, I presume that peer feedback is just as important.

PS: For further reading-

1. Trends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019
2. Interns Are Increasingly Using Mental Health Services, but More Can Still Be Done
3. Why Do Doctors Commit Suicide?
4. Thanks for the Feedback: The Science and Art of Receiving Feedback Well

PPS: Please remember tell me what you’re thankful for so I can make a residency gratitude list for our special Thanksgiving edition of Program Director’s Notes! Deadline: Wednesday 5PM!

MDS