Just got back feedback that was basically, "you're annoying."

[ChordaEpiphany]

I've been on a sub-I for about 3 weeks and have been working primarily with a PA and some M3s in addition to my senior and the attendings. Today the PA sat me down for feedback and basically said I was annoying. She said I don't pick up on social cues and interrupt constantly when she's trying to teach the M3s.

I can see where she's coming from. I have ADHD and get excited. I probably blabber too much, and working 12-14 hour days isn't helping. If she pulls up a CT and starts pointing something out, I'll sometimes ask a question of my own and sometimes clarify if I can tell the M3 is just nodding their head and pretending to understand. Honestly, I saw it more as a discussion than a formal teaching session, but the PA took it personally and has clearly been building resentment for a few weeks. Just a year ago I was in the M3's shoes and totally know what it's like to feel like you have to pretend to understand everything. I was always super grateful for the M4s that explained things to me, because they knew how to explain it at my level (because they at least sort of understand how much I know and don't know). At the same time, she's trying to teach, and I need to respect that. She also mentioned I probably don't do the same with the attendings. FWIW, I'm pretty sure I do the exact same thing with the attendings, and they've mostly just been jazzed that an M4 is so excited to get involved teaching. Gotten good feedback from them so far, specifically citing how good I am with the M3s. One of my M3s even specifically went to the attending to rave about how great I've been (which, wow, I'm extremely grateful for).

I'm a little crushed by this, and I'm upset I made someone feel so disrespected. Tbh I struggled a lot socially growing up and really worked hard, like specifically worked on overcoming lack of confidence, shyness, and talking too much once I got comfortable. Managed to get honors-level evaluations in all rotations, which I thought was a good indicator that I was actually making a good impression and that people actually enjoyed working with me. I finally felt confident.

I know I get overly excited, and I'm really eager to step into a teaching role as it was a staple of what I did before med school, but I'm probably not ready based on my knowledge base and status as a student. I'm just kind of crushed and feel extremely put down. I don't really care if I'm growing as a physician if I'm backsliding on social awareness and skills I worked so hard to develop.

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[DO2015CA]

Don’t worry. Take it as a learning experience and move along. When you’re a senior, your interns and MS will appreciate it. Really a couple things could be going on 1) you are annoying 2) midlevel feels intimidated because they don’t have the answers to the questions you’re asking because of course they don’t have the foundational knowledge you do 3) ****s rolling down hill. In my experience as a MS, midlevels/nurses were harsh on us because there was a power imbalance and they knew we were wet behind the ears. That’s dynamic changes sometime in residency.

I got “feedback” of overzealous as an intern but went on to be the “best teacher” senior. Medicine is full of dick measuring. I used to let it bother me but I no longer do

 

[operaman]

If you honored all your M3 rotations and your grades were partly based on clinical evals, then you’re fine. Honors in M3 is basically a sign of how much people like you, and if everyone liked you I think it highly unlikely you’re suddenly annoying. Annoying students don’t get honors most of the time unless it’s one of those schools where grades are purely based on shelf.

It’s certainly possible it’s you so take the feedback as information and try to be aware of how you’re coming across, but I wouldn’t make too many changes if you’re honoring everything already.

There’s also an issue with many PAs having a little chip on their shoulders. Despite what they like to think that their training is the same, it’s not and it’s not long in residency before you will exceed their knowledge base. If this is one of those “I coulda been an MD if I wanted to” kind of PAs, you may just be reminding her of her own shortcomings and stealing her few moments of glory where she knows more than someone she’s teaching.

So accept the feedback as info that applies to this one person, but don’t generalize it beyond that point unless you get corroboration from others.

 

[NotAProgDirector]

The main lesson to learn here is to try to "read the room". Sometimes being super eager and helping out is what is needed. Sometimes staying quiet and just participating is needed. Chances are there have been hints you have missed over the last three weeks that you were rubbing this person the wrong way. Think back. Maybe get input from others. What did you miss? How can you avoid that in the future? That's what you want to get out of this. Your overall performance appears fine.

Being involved, helping teach, supporting M3's - these are all strengths. We sometimes ask people what their greatest weakness is as an interview question. IMHO, almost everyone gets the question "wrong" -- they make up something that isn't really a weakness (I work too hard). Your greatest weakness is when you apply your strength to the wrong situation. Because it's a strength, it's hard to see that it's causing damage rather than being helpful.

 

[phonyreal98]

I mean you're a member of SDN, so what did you expect? /s

 

[mrbreakfast]

Medicine is about both being knowledgeable/skillful in your craft (being able to help) and doing so with good bedside manner and professional courtesy (so people actually want your help). The latter takes more time to develop than the former, especially the "playing well with others." In residency especially you will encounter plenty of nurses who are quick to take offense, plenty of other residents, and attendings, who have imposter syndrome and spend their days waiting for someone to challenge their management of a patient, and plenty of PAs/NPs/physicians who view gentle feedback and harsh criticism as indistinguishable. Like other social spaces, it involves nuance or reading between the lines, and if you consistently can't do that well, your training will get more difficult.

On the other hand, as a senior resident (and probably as an attending as well, though no one does it) I would find a sub-I who interrupted my teaching to try to teach themselves a little annoying. It's great that you also want to teach, and there should be plenty of opportunities, but perhaps pick your timing a bit better.

 

[Wamuu]

I wouldn't be too thrilled about paying to be in rotations during school only to be taught by a PA or NP since they don't have the foundational knowledge/experience. In this case, if the attendings (the people who are ultimately going to be your peers) appreciate your ability to ask questions and face uncertainty, then that's a win in the end.

 

[percyeye]

Learning and understanding social cues can be done and just as important as learning textbook medical knowledge. You can be pretty damn smart but if you're annoying it can just kill the culture in any work place. I know of a very coveted fellowship where they get top prospects but they say 80% of what they are looking for is someone who isn't annoying and is pleasurable to hangout with for a year.

 

[GoSpursGo]

Ask the attendings for feedback.

The feedback you have received from the PA may still be valid, however I'd try to hear it from them directly first.

 

[Redpancreas]

The PA could be right but who the hell cares what she/he is saying. Get your feedback from an actual attending. That’s what you’re going to be doing for the next 40 to 50 years.

 

[ChordaEpiphany]

If you honored all your M3 rotations and your grades were partly based on clinical evals, then you’re fine. Honors in M3 is basically a sign of how much people like you, and if everyone liked you I think it highly unlikely you’re suddenly annoying.

Yes our evaluations are majority subjective evals. I generally did very well with everyone, attendings and residents alike. My M3 has been amazing and we've been chill, so I told her the situation and asked if she felt like something was off or if I was missing some sort of cue to shut up. She said she was shocked and never once interpreted it that way (and that she really appreciated my tips, because they were actually aimed at the M3 level and practical for the wards).

Regardless, I'm obviously just going to shut up for the remainder of the sub-I.

The main lesson to learn here is to try to "read the room". Sometimes being super eager and helping out is what is needed. Sometimes staying quiet and just participating is needed. Chances are there have been hints you have missed over the last three weeks that you were rubbing this person the wrong way. Think back. Maybe get input from others. What did you miss? How can you avoid that in the future? That's what you want to get out of this. Your overall performance appears fine.

I think I read the room and realized this person didn't like me, but I couldn't for the life of me figure out why. My behavior was remarkably benign, just throwing out a few tips in the workroom during an ongoing, open discussion. These were not chalk talks. This was like, M3 asks a question between cases, PA answers, I very occasionally either ask a question of my own or briefly say something like, "oh btw, they love to go after that on your OSCE exam," or "they'll definitely ask you this detail when you're on OBGyn so hold onto that". I did the same with the attending and he took me aside to tell me what a fantastic job I did with the M3s and teaching.

FWIW, this PA is now off service and the interns are relieved. Apparently she has a great reputation with seniors (i.e., people who can talk back), but is known for berating people on consults, micromanaging interns, and exhibiting way too much confidence for her overall knowledge level. So I'm venturing a guess that this is an ego problem. Med students are all so subservient and desperate to not rock the boat that they'll take basically any abuse. People become very toxic in that environment because they're effectively immune to criticism and never get honest feedback. I've even saw small changes like this in myself when working in research with rotating students desperate to be an author on a paper or get a spot in the lab. You quickly forget that even though everyone is nice/complimentary, they're hiding their true opinion. It's easy to drift into overconfidence, unreasonable expectations, or just poor social habits because you've stopped getting real feedback. I imagine this is why many rich/famous people become a**holes.

On the other hand, as a senior resident (and probably as an attending as well, though no one does it) I would find a sub-I who interrupted my teaching to try to teach themselves a little annoying. It's great that you also want to teach, and there should be plenty of opportunities, but perhaps pick your timing a bit better.

Definitely. To clarify, it's not like I was launching into a full on teaching session. I was just commenting on the pieces that were notably high yield, which the PA doesn't really have any sense of, and others have found this entirely benign and/or helpful. I've done the same with residents and we've all been totally chill. Never sensed even a hint of anger, and the residents still buy me lunch so I can't be  that annoying. I think my primary sin was exhibiting too much confidence in front of a person who needs to feel better than someone else. Still, there are plenty of unreasonable people out there, and there will always be people who have power over me. I need to learn to navigate social situations with these people.

The PA could be right but who the hell cares what she/he is saying. Get your feedback from an actual attending. That’s what you’re going to be doing for the next 40 to 50 years.

I cared because

a) I genuinely don't want to make people feel disrespected.
b) This PA has worked with the attendings for years, and her word will mean a lot come letter time.
c) I need to learn to navigate fragile egos. This is far from the last I will encounter.

I care a lot less now that I've gotten a second opinion from my M3s and know this person's general reputation.

 

[Wamuu]

I have a feeling that just because this PA is well-acquainted with the attendings doesn't mean that their word will be of any consequence. This is bolstered by the fact that you made it clear they have a reputation for being unpleasant. If you all notice, imagine what the people who've been stuck with them see and think.

 

[ChordaEpiphany]

I have a feeling that just because this PA is well-acquainted with the attendings doesn't mean that their word will be of any consequence. This is bolstered by the fact that you made it clear they have a reputation for being unpleasant. If you all notice, imagine what the people who've been stuck with them see and think.

I'm not so sure. Plenty of people are great at maintaining a good reputation with those above them while still punching down.

 

[SurfingDoctor]

Wait till you're an attending and "educate" trainees on how their management doesn't make physiological sense. Then you can feel the pain of medical "education".

Honestly... my approach to this is to truly inform those who have a good head on their shoulders... and ignore those who don't. It has served me well for over a decade at this point.

As critical care physicians, we usually understand physiology pretty good. That is what the profession is about. But it can be off putting to many. I remember my first "feedback" about that so long ago. I was like "oof, that hurts". But then I grew up. Now when my much younger colleagues, who usually care about "education" receive the same "feedback"...

Medical education has so many problems. Feedback is definitely one of them. In the healthcare business world, if you have a direct report, you tell them why they are not good and strategize how to improve.... or you can them. In medicine though... that's called microaggressions or whatever the vernacular is. Due to that, I only provide feedback to those who have hope or who I care about. The rest get some useless rubber stamp so I don't have to hear about it.

From the top down, its good not to be the rubber stamp. That's just career wise in general, but most are okay with being the rubber stamp.

 

[JuicedToTheSocks]

If she pulls up a CT and starts pointing something out, I'll sometimes ask a question of my own and sometimes clarify if I can tell the M3 is just nodding their head and pretending to understand.

Read this and tell me u don't have a problem... kinda self-righteous

Good thing is u recognize it. Also good thing is she's a PA and not an MD. And MS3 gave u great rep w the MD. Overall ur good dude and overthinking it but u can chat w the MD too

 

[DO2015CA]

Read this and tell me u don't have a problem... kinda self-righteous

Good thing is u recognize it. Also good thing is she's a PA and not an MD. And MS3 gave u great rep w the MD. Overall ur good dude and overthinking it but u can chat w the MD too

lol many ms3 are completely lost especially in the beginning of the year. Specifically when I’m explain physiology in a clinical application, a fair number of students just nod like they understand. It’s def not self righteous.

 

[IlDestriero]

A good question is why are you being evaluated by a PA?
But a better question is wby are you being taught by a PA?
Ridiculous.
While a PA or NP or CRNA can teach you things, they really should not be instructing you. In our anesthesia program the only interactions the CRNAs have with the fellows is when they are doing supervision training learning to run 2 rooms. Residents, med students, etc. never.

 

[ChordaEpiphany]

Medical education has so many problems. Feedback is definitely one of them. In the healthcare business world, if you have a direct report, you tell them why they are not good and strategize how to improve.... or you can them. In medicine though... that's called microaggressions or whatever the vernacular is. Due to that, I only provide feedback to those who have hope or who I care about. The rest get some useless rubber stamp so I don't have to hear about it.

I think it's 100% about the intent and not about the feedback itself. In the lab I occasionally gave blunt or even harsh feedback to lower level grad students. I'm still close with each of them, and they were never upset with me. That's because I made it abundantly clear that I'm here to support them. The opposite of praise isn't harsh feedback, it's indifference. Feedback is great when coming from someone who is rooting for you. It's awful coming from someone who could care less if you live or die. I've been told bluntly by my senior many times now that I'm doing something wrong. I'm holding this type of scalpel wrong, I missed a key lab value for this patient's presentation, etc... She's blunt, but I can tell she's blunt because she wants me to be better.

As you said above, you only provide feedback to those you "have hope for" or "care about." Everyone who passes under you will be a physician, regardless of whether you "have hope" for them. They're all top notch trainees, and if you don't think so then you have never worked a job where you trained the average person. I think they likely all deserve mentorship coming from a place of wanting them to be better and  rooting for them to succeed. If they're getting upset at feedback, it's probably not the feedback. It's the feedback iso feeling that you're not there to support them.

The reason this feedback was so upsetting to me was that I could tell it did  not come from a place of support. She wanted me to know that she resented my behavior, and she had no intention of ever helping me succeed.

 

[SurfingDoctor]

I think it's 100% about the intent and not about the feedback itself. In the lab I occasionally gave blunt or even harsh feedback to lower level grad students. I'm still close with each of them, and they were never upset with me. That's because I made it abundantly clear that I'm here to support them. The opposite of praise isn't harsh feedback, it's indifference. Feedback is great when coming from someone who is rooting for you. It's awful coming from someone who could care less if you live or die. I've been told bluntly by my senior many times now that I'm doing something wrong. I'm holding this type of scalpel wrong, I missed a key lab value for this patient's presentation, etc... She's blunt, but I can tell she's blunt because she wants me to be better.

As you said above, you only provide feedback to those you "have hope for" or "care about." Everyone who passes under you will be a physician, regardless of whether you "have hope" for them. They're all top notch trainees, and if you don't think so then you have never worked a job where you trained the average person. I think they likely all deserve mentorship coming from a place of wanting them to be better and  rooting for them to succeed. If they're getting upset at feedback, it's probably not the feedback. It's the feedback iso feeling that you're not there to support them.

The reason this feedback was so upsetting to me was that I could tell it did  not come from a place of support. She wanted me to know that she resented my behavior, and she had no intention of ever helping me succeed.

The person most invested in your career… is you. The rest are mostly superfluous.

 

[operaman]

I think it's 100% about the intent and not about the feedback itself. In the lab I occasionally gave blunt or even harsh feedback to lower level grad students. I'm still close with each of them, and they were never upset with me. That's because I made it abundantly clear that I'm here to support them. The opposite of praise isn't harsh feedback, it's indifference. Feedback is great when coming from someone who is rooting for you. It's awful coming from someone who could care less if you live or die. I've been told bluntly by my senior many times now that I'm doing something wrong. I'm holding this type of scalpel wrong, I missed a key lab value for this patient's presentation, etc... She's blunt, but I can tell she's blunt because she wants me to be better.

As you said above, you only provide feedback to those you "have hope for" or "care about." Everyone who passes under you will be a physician, regardless of whether you "have hope" for them. They're all top notch trainees, and if you don't think so then you have never worked a job where you trained the average person. I think they likely all deserve mentorship coming from a place of wanting them to be better and  rooting for them to succeed. If they're getting upset at feedback, it's probably not the feedback. It's the feedback iso feeling that you're not there to support them.

The reason this feedback was so upsetting to me was that I could tell it did  not come from a place of support. She wanted me to know that she resented my behavior, and she had no intention of ever helping me succeed.

One of my favorite articles on this subject and one that inspired a slew of additional articles agreeing and disagreeing with its thesis:

The Feedback Fallacy

For years managers have been encouraged to candidly praise and criticize just about everything workers do. But it turns out that feedback does not help employees thrive.

www.physicianleaders.org

Originally published in HBR but that appears to be paywalled now, but found it here for free.

Focuses more on business but the underlying concept is the same and I think I we’ve all experienced some form of this. I know that I learned nothing about becoming a better physician from any formal feedback session. The whole concept of written evaluations is so annoying to me that I never read one either in med school or residency. Not a single one. But I do have the voices of great teaching physicians in my ear every day in every patient encounter and every surgical case. There really is an art to teaching and inspiring people and I don’t pretend to know how to quantify it, but like Potter Stewart and pornography, I know it when I see it.

 

[ChordaEpiphany]

Focuses more on business but the underlying concept is the same and I think I we’ve all experienced some form of this. I know that I learned nothing about becoming a better physician from any formal feedback session. The whole concept of written evaluations is so annoying to me that I never read one either in med school or residency. Not a single one. But I do have the voices of great teaching physicians in my ear every day in every patient encounter and every surgical case. There really is an art to teaching and inspiring people and I don’t pretend to know how to quantify it, but like Potter Stewart and pornography, I know it when I see it.

I don't think there's a big difference when it comes to the fundamentals of teaching/mentorship in medicine vs. other work environments. The same things I learned teaching/mentoring in the lab directly translated to teaching/mentoring on the wards, however limited my role. Notably, I've found:

1) People do not learn if they are discouraged. They simply do the bare minimum and redirect to other areas of their life or work for satisfaction. You see this constantly both online and IRL (e.g., "Ugh, I hate [specialty], I'm going to pass this shelf and never think about it again." "Stop chasing accomplishment and focus on getting that bag.").

2) If you provide feedback, go out of your way to provide a second opportunity to incorporate it.

3) Do not nitpick as a task is ongoing. Instead, let them finish a significant portion of the task, gift them the accomplishment of having completed it, and tell them how to improve piece by piece. Few things are as demoralizing as being interrupted continuously.

4) Never assign half a task. People will skip over critical pieces of the task as soon as they encounter resistance, and they never take ownership of the task and let it slide if something else comes up.

5) Always recognize the difference between your preference and what is truly incorrect. People in medicine are particularly bad about this one, and it leads to "I can't win" feelings, which results in problem #1.

FWIW, I try to follow this even as an M4 working with brand new M3s, though it's obviously a much more limited role, and I'm very aware of the relatively small gap between us in terms of knowledge/experience. My attendings recently told me they've never had M3s so enthusiastic about an M4 or intern before, likely because they break all the rules above and teach in a way that makes them feel better, not in a way that affords any autonomy or encouragement to the student.

Also, as an update to the original topic, it turns out that most of the interns dislike working with this PA. This was offered to me by an intern without any prompting. I simply said I felt like I wasn't quite sure what my tasks were supposed to be or how I was supposed to proceed on my sub-I, and they immediately shot back with, "Yeah well [PA's name] is really hard to work with. It's not you." They then explained to me that many of the interns had either had direct altercations or passive aggressive difficulties with this person. I've never felt so relieved to know I'm not truly the problem.

 

[voxveritatisetlucis]

Why are you rotating with a PA?

 

[LucidSplash]

I’m glad you’ve been able to get other information to let you know this at least wasn’t a primarily you issue. It’s probably time to let it go and move on mentally and also let this thread die. Sounds like you had a resolution to both your question and the problem and there’s probably no additional value in perseverating on it.