Radical Candor in Medical Education

From the August 4, 2023 issue of the Transformational Times

Radical Candor in Medical Education 

 

Kathlyn E. Fletcher, MD MA – Program Director, Internal Medicine Residency 

 

 
Dr. Fletcher highlights a Kern offering to new interns to prepare them for their role as educators. These sessions took place during orientation and combined a workshop on how to show learners that they matter with a workshop on how to give effective feedback.  These are the building blocks of medical education radical candor ...

 

My introduction to radical candor 

 

I first heard the concept of radical candor from my sister Julia, who is a retired Navy intelligence officer. I must have been talking with her about how hard I thought it was to give feedback, when she got out a piece of paper. She drew a 2 x 2 table that is the central figure in a book about how to be a great supervisor. She explained that to give impactful feedback, you must 1) care about the person you are talking to and 2) be honest.  

 

I proceeded in my usual path to change -- somewhat slowly. I bought the book Julia was referring to called Radical Candor by Kim Scott and started reading it. I got about halfway through before I dropped it in the bathtub and decided that I had read enough to “get” it.

 

A few concepts in the book specifically resonated with me.  

 

First, the quadrant in which we care about the person, and we are honest is called “radical candor.”  The quadrant in which we care about the person, and we are NOT honest is called “ruinous empathy.”  

Ruinous empathy struck a chord because I thought about all the times that I had convinced myself I didn’t need to be completely honest in my feedback. Phrases went through my brain like, “I’m sure she will get better; it is so hard being a July intern.” Or “It’s impossible to know everything as a third year medical student; I am sure he will fill in that knowledge eventually.”  I spent SO MUCH time in ruinous empathy.   

 

As I began trying out radical candor, I came to see that if I believed in someone’s ability to improve, then I had to be honest about how they could do so. I started framing my feedback by saying “I wouldn’t suggest this to you if I didn’t think you were capable of it.” I think many learners were grateful for the careful attention to how they could improve. 

 

Developing medical education radical candor skills in the residents 

 

For the second year in a row, the Kern Institute has sponsored half-day workshops for incoming residents to allow them time to focus on their skills as teachers. In 2022, interns from five residency programs participated. In 2023, thirteen programs participated.  

 

These workshops focused on two skills: how to make learners feel like they matter and how to give effective feedback. Medical education radical candor skills!  

 

The two sessions on “mattering” this year were run by Karen Marcdante/Rachel Ashworth and Andrea Maxwell/Caitlin Patten. 

 

When the facilitators asked participants to describe times on clinical teams when they felt like they didn’t matter, the interns shared poignant moments that have stayed with them for years. The interns also described times that they knew they mattered. 

 

As I sat through these sessions, I noticed how small things made a big difference toward making someone feel that they mattered: calling them by name, giving them meaningful work to do, asking them about their life. Importantly, it doesn’t take long to establish that you care. You can set the stage in less than a minute, which means you can give honest feedback without waiting days or weeks to assure yourself that learners know you care about them.  

 

After the mattering sessions, interns learned how to give effective feedback. Himanshu Agrawal ran one workshop on feedback this year, and Seth Bodden ran the other. Their frameworks for how to give effective feedback included being timely, actionable, and (of course) honest. As with mattering, the intern participants could recall both helpful and not helpful feedback (“read more,” “good job”). Making time and finding space to give personalized feedback is itself an act of caring. 

 

The concept of radical candor reminds us to show learners that we care and that we must be honest in our feedback.  

 

I would take it one step further and say that giving honest, effective feedback is an extension of our caring and demonstrates our belief in the learner’s potential for flourishing in medicine. 

 

It was so freeing for me to realize that if I cared, then I had to be honest. No more ruinous empathy. Bring on the radical candor.  

 

 

Kathlyn E. Fletcher, MD, MA, is a professor in the Department of Internal Medicine at MCW. She is the program director for the Internal Medicine residency program and co-director of the GME pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.