Effective Feedback and Difficult Conversations:
Readings and Articles

Bonetta L. “Writing a Letter of Recommendation.” Addendum to Making the Right Moves: A Practical Guide to Scientific Management for Postdocs and New Faculty. Second edition. Burroughs Wellcome Fund‐Howard Hughes Medical Institute; 2006: 1‐17.

A helpful collection of “tips” for mentors about the dos and don’ts of writing letters of recommendation for postdocs and junior faculty. Two sample letters demonstrate the importance of specific wording in determining what you want the letter to convey to the reader.
(11 references)

Ende J. “Feedback in Clinical Medical Education.” JAMA. 1983; 250: 777‐781.

A classic paper on the necessity of giving feedback to trainees in clinical medicine, the barriers to doing so, and guidelines. The guidelines suggest that feedback 1) be part of the relationship between the teacher and trainee; 2) be well timed and expected; 3) be based on first‐hand data; 4) be regulated in quantity and limited to remediable behaviors; 5) be phrased in descriptive, non‐evaluative terms; 6) deal with specific performance, not generalizations; 7) include subjective data labeled as such; and 8) deal with decisions and actions, rather than assumed intentions or interpretations.
(19 references)

Gigante J, Dell M, Sharkey, A. “Getting Beyond ‘good job’: How to Give Effective Feedback.” Pediatrics. 2011; 127: 205‐207.

This paper provides a five‐step framework for giving formal feedback to learners in the pediatric setting: 1) outlining the expectations for the learner at the start of the learning experience, 2) preparing the learner to receive feedback, 3) encouraging self assessment by asking the learner how she thinks she is performing, 4) telling the learner how you think she is doing based on specific observed actions and changeable behaviors, and 5) developing a plan for improvement.
(17 references)

Thomas JD, Arnold RM. “Giving Feedback.” Journal of Palliative Medicine. 2011;14: 233‐239

This recent paper by two palliative care physicians reviews educators’ and learners’ attitudes towards feedback, builds on Ende’s guidelines to provide a helpful algorithm for giving feedback, and describes parallels between giving difficult feedback and breaking bad news. The latter emphasizes the importance of titrating the amount of information provided so that it can be integrated, attending to the resultant affect, and making a follow‐up plan for next steps.
(36 references)

Jo Shapiro, MD – Presentation: A Crucial Component of Professional Interactions that Work

A slide deck of Dr. Shapiro’s talk about the necessity of providing and receiving direct feedback about professional behavior in the medical setting.