Be Like Sheldon, Part II

On receiving feedback

In the last post, we discussed how Dr. Sheldon Cooper, a fictional character from The Big Bang Theory, provides an inspiration for honest feedback. This was from a point of view of a leader or faculty giving feedback. Of all the 40+ posts I have written, this one received the most feedback. It resonated the most with those who are leaders and need to give feedback often. What I heard the most was how they related to the difficulty of giving feedback whilst caring for their team members. To be like Sheldon requires us, as leaders, to be authentic and to create an environment of honesty. (Note: I will use the term leaders or faculty interchangeably; and the term team members or students interchangeably).

Creating an environment of honesty and being authentic is not enough for successful feedback. It is necessary but not sufficient. Team members and students need to want to learn from their leaders and their teachers. The giver and receiver of feedback both must be willing in order for the process to work most effectively.

As mentioned in the last post, Sheldon becomes more empathetic during the course of his development. Being a scientist, he first observes the impact of the situation and another person’s reaction, confirms his observation with those around him (checks his assessment) and over time learns appropriate empathic responses. There is nothing more scientific and SPIKES-way than this trial and error with hypothesis generation, testing, and constant improvement.

So just like in the last post where I talked about wanting to be Sheldon in terms of giving feedback, I desire to be like Sheldon in receiving feedback.

I am only a PGY-23

At the beginning of each academic year, when I meet new students or fellows, I remind them that one of the best things a learner can do is to seek and receive feedback. I advise them to do that by using one of the below phrases I learned many years ago:

I am only a 1st/2nd/3rd/4th year student, can you help me?

I am only a PGY-X, I am trying to learn… what can I do differently?

I tell them I use the phrase“I am only a PGY 23” today. I think my tone gives it away that the phrase is not used often. There are different phrases and more importantly, behaviors that tell those around me that I am open for feedback.

I used the following phrase at a meeting this week. “If you do not give me feedback about what I am doing wrong, I guarantee you that I will not change my behavior.” This was in front of several dozen junior team members who help me with our clinical trials. The most junior person in the team takes my notes and enters data in the clinical trial case report forms (CRF). If I make a mistake in the first visit (for example, I put in Eastern Cooperative Group’s Performance Status (ECOG PS) rather than Karnofsky Performance Status (KPS), the data would be erroneous or missed. If I do not know that I made a mistake the first time, it is 100% likely that at every subsequent visit, I will make the same mistake. On the other hand, if the team members tells me right after the first visit that this study requires KPS rather than ECOG, I would avoid making the same mistake at each visit. It will help them complete their work accurately each subsequent event and will save all of us a lot of time monitoring visits or filing deviations from the protocol.

By announcing this in a large meeting, and asking for their help, I hope that they will feel comfortable reaching out to me with every little mistake I make, so that my future work will be incrementally better. In the process, their work-life may improve as well.

So, as a leader we can model behaviors that make it “ok to continuously improve.”

The purpose of the recommendation for learners to seek feedback is twofold. When the learner announces their intention to seek feedback, first and foremost, they let the faculty know that they want to improve and it shows their willingness to listen (another necessary condition for their success). Secondly, they are activating an important part of the faculty’s psyche. Most, if not all, teachers and doctors want to help. This priming action create a “win/win” scenario, where the faculty is now focused on the learner’s success. Success for most faculty is correlated with success of their students, and giving honest and constructive feedback allows them to achieve this goal. Thus, both learner and faculty are aligned.

Let’s focus on both of this in the next two sections.

1. Being open to feedback

In the post on “goal oriented feedback,” we used the SPIKES framework to give feedback and it was mostly from the feedback giver’s perspective. There is an important reciprocal behavior in receiving feedback. Reviewing the post, the steps for feedback are:

1. Identify Goals (Set up - Both Learner and Faculty Responsibility)

2. Establish specific outcomes and a plan for success (Learner responsibility with faculty assistance)

3. Observation of the encounter

4. Provide Information / Feedback (Faculty responsibility to provide feedback in the framework from #1 and #2 above). Faculty excel at this step by asking the learner for their own evaluation and insights rather than lecturing on encounter (thus giving information and providing empathy)

5. Summarize the encounter (Learner responsibility).

By asking for feedback and providing a framework, the learner provides a roadmap for their own success.

This works very similarly in other leadership environments. At weekly, monthly, or yearly meetings, having a framework for self evaluation and observed evaluations allow for improved outcomes. A leader, in addition to creating a work environment that is judgement-free and authentic, needs to have frequent opportunities for check-ins to facilitate feedback and nudging. The frequency depends on the receiver and the giver. In the beginning it can be more frequent and later, less frequent.

Not all students are created equal; not all team members are created equal. In a class of a dozen students, I will probably have 2-3 who know exactly what skills they need to work on, and there are another 2-3 who do not have the insight or may even have the wrong insights about their strengths and weaknesses. A leader’s responsibility is to assess their team member’s insight about their skills and behaviors as they relate to each of the domains that are judged on (required for them to be successful). The explicit strike out is intentional. A relation where the focus is on judging is a different one than another that is focused on success.

So, both parties need to establish a common goal, and ideally the learner or the team member takes charge of the process when they have the insight.

Priming for a win/win

By asking for feedback from a faculty or leader, and defining this in terms of “win/win” it allows for the creation of an environment for self improvement and long term success.

Let me be honest, THIS HAS BEEN THE HARDEST THING FOR ME. It took me until probably my 40s to learn to want to get feedback. Early in my career, I would look at bad grades or critical assessment as failures. When I applied for a grant and review was negative, it was physically difficult for me to read all of it. It was only after several big life changing experiences and modeling shown by my mentor, Paul Duberstein, PhD, that I learned to be better at developing win/win scenarios. Dr. Duberstein modeled the behavior by doing very specific things. Once we established a mentoring relationship, he demanded/suggested/requested few things:

• We meet regularly, in the beginning it was weekly and later less often

• I was responsible for the agenda

• He taught me how to ask for feedback by modeling (he asked me for feedback and listened to what I had to say; he looked at every comment I made on the proposal we worked on and adopted as appropriate)

These behaviors led to changes in how I do things. I now believe in “incremental” and “small” changes (earlier I was looking for perfection out of the gate, now I am ok with good enough and striving to be better incrementally). Continuous, and intentional, improvement is the key to development and growth.

I would be remiss if I did not share my “why” - why was I avoiding feedback for many decades? Why was I resistant? A big part is ego. Failures were seen as just that, a failure. A bad grade was just that, a failure. I don’t want to fool anyone and say that failures happened a lot. I have always worked hard, I am smart, I am diligent, and have accomplished many things. So, I had many more successes which allowed me to avoid “failures” or focusing on “failures.”

It is likely that I met Dr. Duberstein at the right time (when I was ready) and he demonstrated the right skills (humility) which resonated with me and led to a change in my behavior. Thank you Dr. Duberstein!

So, as I tell my 17-year old, “Learn from my mistakes, kid…” I highlight this to you to do the same. Learn from my mistakes. As a learner, as a team member, and as a leader, interrogate your behavior to see if you are focused on avoiding failures or learning from your failures. If it is the former, ask the why. Why is it hard to face your failure? Talk about your failure? See if you can incorporate the following quote in your work/real life (attributed to Thomas Edison).

"I have not failed. I've just found 10,000 ways that won't work.”

Regardless of who you are, my 17-year old going to college this year, or a very successful leader of a large business, challenge yourself to be a learner. Challenge yourself to be Sheldon. Sheldon, who has the humility to acknowledge he does not know emotions, has the genuine interest about self-improvement and in his own way, works to improve one step at a time.

I would love to hear your stories of giving and seeking feedback.

With humility and in awe of Sheldon,

Biren