“Any feedback for me?” Shelly, my resident, is wrapping up a successful intern year in the emergency department during which, as far as I know, she still hasn’t killed anybody. At the end of the night shift, we were both exhausted and ready to head home to our families, hobbies, and beds.

Yet she still found the gumption to ask for feedback, a customarily painful experience. Most supervisors just can’t resist adding in some acidic criticism after the token praise.

“You did well with blah blah, but you really need to work on this and that and this other thing, which absolutely cannot happen again, and that time you were totally wrong, I’d like you to inform me ahead of time when you get confused before it becomes a real disaster, and …”

Often coated in flowery professional verbiage, feedback tends to focus on the negative and highlight failure and often degenerates into emotional flogging. “Constructive feedback,” lauded as the ultimate educational tool, is still essentially negative, albeit coupled with usable strategies for improvement. When it comes to the trainee’s confidence and self-esteem, it is difficult to avoid having constructive feedback become destructive.

I had to admire her diligence, asking for feedback after an overnight of hard work. Impressed, I decided to do better than feedback.

She was going to experience “feedforward” for the first time. Feedforward radically turns negative to positive. Instead of beating up, it bolsters and builds. Here we go …

Feedforward Step 1: “What was your best case today?” I asked.

“What?!” she gasped, looking at me with suspicion.

“Not a trick question. I just want to hear about the case that worked out well, where you were awesome. Trust me, it’s worth the time.”

Still suspicious, but playing along, she began with caution, but soon was speaking with genuine excitement.

“It was that ultrasound-guided IV case, actually,” she said. “I didn’t get the IV; you had to take over there, but I figured out his CHF, optimizing his oxygenation and ventilation. I also addressed his concurrent COPD and remembered to check for hypercarbia. I even thought of the best antibiotic regimen for possible, but less likely, pneumonia. I remembered the renal adjustment of dosing. I felt in control. I felt empowered. He was my patient, I was his doctor, and I was making him better. I was using my knowledge and skills to keep a human being from dying. It was awesome!”