• Dr Sally Ayesa

Using feedback

If you are running practice viva cases in the lead-up to exams there is one thing you aren't short of - feedback. But feedback (like case presentations) is of variable quality and sometimes it can be hard to know what to do with it. It can also be hard to balance the good with the bad, and if you are having a particularly rough day it can be hard to hear the good things coming out of the mouth of your tutor or colleague.


Some viva tutors will naturally give out balanced feedback, with the aim of building you up and giving you areas to improve in the same discussion. I try and do this, but have had times where I haven't managed this balanced as well as I hoped. The best feedback is encouraging but honest, spurring the candidate forward while highlighting areas they can improve.


Although it was sometimes a bitter pill to swallow, I had to keep reminding myself the improvements and criticisms were what I needed. Those last few weeks were about gap plugging, which would have been useless if I didn't know where the gaps were.


Some tutors give out less constructive negative feedback, and more positive reflections. This can be excellent on a day when you are feeling down-trodden and need your spirits and confidence lifted. When it isn't so useful, is when you have your spirits up and are back in the groove of self improvement. I think in these situations you can tease out the areas for improvement by having a quick chat with the tutor before or after the session. They might tell you that you nailed it, but at the same time that case you did on pulmonary nodules was less smooth than some of the others. Bang - something to work on.


Some sessions - however - make you feel like all the examiner sees is negative. These are can be the hardest sessions to rationalise, and have the greatest potential for damage to your campaign.


The first thing to ask yourself is - were the cases fair? This may be hard to work out early in the piece, however if you are nearing exam day you will be starting to have an idea of what are exam level cases and fair presentations. I had a tutorial like this, where I did three cases which were unlike anything I had done or practiced previously, bumbling through all three. It was with a boss who didn't show cases very often and I had never really worked with before. To make matters worse, I had stayed back for the session (on my day off), he was late and I had to leave halfway to collect my kids.


For the first little while I was angry and embarrassed. But then I started thinking about the cases, eventually deciding they were weird projections and obscure diagnoses. The feedback was about as vague as the diagnoses. I decided to let this one go and not attend any future tutorials with this boss. It was doing more to break me down than build me up.


If you think the cases were fair, ask yourself - what went wrong? Were you having a bad day? Did you just come off another suboptimal tutorial and your confidence was dented? Was the case mix in an area that you haven't seen or practiced before, and perhaps are struggling in?


The first thing to do is to pick yourself up, which is sometimes easier said than done.


When you are feeling stronger - after lunch, coffee, a good chat or a good night's sleep - then you can start to pick apart the session. Even if your bad run was a single case or a group of cases, I have felt that the best way to work it out is to pick themes. Remember exams are a test of your lateral thinking and synthesis, which will be a reflection of your understanding of a broad topic and how it relates to practice. A series of wrote-learned presentations will not get you through a radiodiagnosis viva. Examiners purposely take cases which require extension of your knowledge, lateral thinking or both. I know this because an examiner told me so.

Acknowledging and seeking feedback is important in honing your skills before viva day

So how do we pick out a theme to target future study?


1. Ask the tutor. If you have a reasonable relationship with the tutor you can do this in person, or you can shoot an email. The worst that will happen is that they ignore you. The tutor might divulge something about your technique (e.g. "I thought that you lacked a clear direction with the way you worked through the cases" or "you didn't ask for extra views and forgot management") or above your knowledge deficits (e.g. "I thought that you handled the thoracic mass cases well, but struggled when assessing interstitial lung disease.) You can go away and read up on interstitial lung diseases and test yourself again with the subsequent session. Or practice some cases on your own or with your study group to hone your technique.


2. Ask your colleagues. This can be terrifying, but humbling. Remember you are all in this together, all have rapidly expanding knowledge bases and skill sets and have the ability to bring each other up. You can either ask how you think you went (which in practice will usually be met with encouragement and no-one wants to knock you down) or you can ask for advice. One of my study partners and I reached this level of honesty where we could say to each other - "Hey, I saw you nail that retroperitoneal fibrosis case last week and I just messed a similar case up. How did you work through it to get the diagnosis?". It was really helpful, if you have that kind of relationship with your colleagues.

3. Ask yourself. Being self critical is something I am a little too good at. At times, it has been crippling and at times very useful. When it was useful was looking back at my unsuccessful practice sessions and trying to work out where I stumbled. Take a breath, and think about the times in the session when you felt relaxed and when you were panicked. If your blood ran cold the minute a prostate MRI came up in the light box then maybe you should spend a bit of time working on that particular breed of cases. I did this over and over for different scenarios ... pineal region masses, paranasal sinus tumours, upper zone fibrosis, adrenal lesions, soft tissue tumours. While you shouldn't have your head in a textbook all the time, this is where the textbooks come in useful.

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