Exhausting (Twice): On Feedback That Stings and Still Teaches

It’s the time of year for faculty to receive cumulative feedback. My personalized email from GME came just before I was scheduled to co-lead a session for our medical students. Should I have delayed reading the email, just in case there was something in there I needed time to process? Sure. Did I do that? No. No, I did not. I thought the feedback would be fine, or even good (it has been the past few years). And all of it was, except for one response in the free-text “opportunities” column. It had the word “exhausting” in it. Twice.

I’ve written about feedback before, but all that prefrontal cortex-generated advice evaporated right out of my brain as I closed my email and transitioned (roughly) to teaching the medical students, my limbic system taking over. Surprise led the way to confusion, which was promptly followed by denial, anger, bargaining, and depression. Oh, you read that correctly. And I know “receiving feedback from medical learners” was absolutely not what Dr. Kubler-Ross had in mind when describing her stages of grief.

Needless to say, I’ve been thinking about that feedback a lot since I read that email. I’m working hard to acknowledge my negativity bias. Studies have shown that our negativity bias is so strong that it takes three pieces of “good” information to outweigh the emotional valence of one piece of “bad” information. I had more than three pieces of positive feedback in that GME email, but the one item of negative feedback continues to weigh heavily. Does that mean my negativity bias is stronger than average? Maybe. It might also mean that I consider myself an expert in being an academic physician. In their 2012 article, “Tell Me What I Did Wrong: Experts Seek and Respond to Negative Feedback,” Stacy R. Finkelstein and Ayelet Fishbach found that “positive feedback increased novices’ commitment, and negative feedback increased experts’ sense that they were making insufficient progress,” leading them to pursue opportunities that lead to growth in response to the negative feedback.

I must recognize that the feedback hit a nerve. When people say negative things about us, they don’t bother us unless we’re already worried they might be true. After letting my hair go gray earlier this year (before I came around to the idea myself that I quite like it), if somebody had said, “Ugh, your gray hair makes you look weird,” I would have had a bit of an existential crisis (and had to re-assess the people I was hanging out with). But if somebody had seen my gray hair and said, “Ugh, your green hair makes you look weird,” I would have thought, “Wait, what? I don’t have green hair. That makes no sense.” No existential crisis, but certainly a moment of consideration about how well Billie Eilish pulls off green hair.

Was the learner saying I was exhausting (twice) 100% correct? No. Do I see the point they were making? Perhaps. When I think of the position medical learners are put in, I can see how a certain level of persistence from all angles to get things done in an ICU can get exhausting for them. And, if I’m being honest, for me too, sometimes.

But feedback is data, not a verdict. I like to think of myself as someone who practices with energy and purpose, pulling up the mood in a clinical space where it’s easy to get bogged down. For some, I might be “too much.” But maybe “being too much” isn’t the problem to solve. Maybe the challenge is to discern when intensity is needed - and when a gentler approach might actually help the learner (and me) more.

Is this what Kubler-Ross’s “acceptance” feels like? (Might as well round out the metaphor, right?) I will continue to reflect. I will make space for the possibility that my presence might need recalibration in some contexts. And I will continue to do the work to hold both truths: I am deeply committed and occasionally exhausting. One does not cancel out the other.

To anyone else reading this who has been called too much, too intense, too direct, too anything, consider this your invitation to pause, breathe, and ask:

What part of this feedback is about me, and what part is about their experience of me in that moment?

And then:

Is there something I want to shift, not because I should, but because I choose to grow?

Our work is too important to be derailed by defensiveness or diluted by people-pleasing. Feedback, even when painful, can be an invitation to align more closely with the kind of educator - and person - we want to be.