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November 22, 2021

Medical Mentoring—Critique Me, Please

Author Affiliations
  • 1Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. Published online November 22, 2021. doi:10.1001/jamainternmed.2021.6742
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    2 Comments for this article
    Excellent points
    Stephen Workman |
    As a physician with an interest in music education I have attended voice masterclassses. Feedback is given in service, not of the wellbeing of the performer, but solely with the intention of improving the performance. Critics and peformers are united in valuing the art over the self. I always reflect on the courage of the performers and on their unreserved commitment to their art. Of course much is at stake. A career as a professional musician is a privilege that can only be earned, by most, by a relentless commitment to excellence. Sadly this same mindset is not widely embraced in medical education. Such a failure is ethical as well as pragmatic. Musicians who cannot face the music hurt mainly themselves. Failures in medical education cause harms not only to physicians but also to patients.
    Structured critiques
    Elaine Giedrys-Leeper, BDS FDSRCS MScD MRD | Retired Consultant Dental Surgeon
    In the 1990's The "Training the Trainers" course at the Royal College of Surgeons had a very specific and I thought, very neat way of initiating and conductng critiques. It went like this :

    1. The trainer / mentor asks the trainee "What do you think went well ?"
    2. The trainee tries to come up with at least 1 positive from what they routinely perceive to have been a disastrous episode
    3. The trainer / mentor gives his / her ideas of what went well and why they think that
    4. The trainer /
    mentor then asks the trainee "And what do you think you could have done better / what would you do differently next time ?"
    5. The trainee is then free to berate themselves but in a potentially more reflective frame of mind - in particular how will the same disaster not happen again
    6. The trainer shares what he / she felt could have been done better / differently and why and how.

    The actual words used seemed to me to be critical - "well, better, differently" The trainer was never allowed to say the word "but" e.g. "I thought your final suturing was good ... but ...."

    It seemed to provide a neat, contained, non confrontational form of reflection on everyday practice and seemed to be a reasonable confidence builder.