I never teach my pupils; I only attempt to provide the conditions in which they can learn. –attributed to Albert Einstein

For the sake of my students’ future patients, I must teach in the here and now.

“About that central line you put in during the code…”

The moment of truth. The resident looks up from the paperwork. His pupils dilate from the tsunami of adrenaline released in response to my seemingly innocuous comment. Officially, he is getting “constructive feedback”; emotionally, he is suddenly on trial and anxiously awaits a verdict. Guilty or innocent?

Medical educators, scarred by the “feedback hazing” of their own training, often feel being “cruel to be kind” is par for the course when confronting students about errors, limitations, and need for development. Perceiving feedback as painful but necessary, the teachers demand that students “take it in stride.” Most students in turn find the punitive emotional burden of negative feedback deeply distracting from its educational value.

In teaching medicine, coaching has emerged as a method focused on instruction and skill building, in contrast with the judgmental and punitive nature of performance evaluations (JAMA 2011;306:993-4). Coaching incorporates feedback intended to empower and teach rather than criticize and demoralize.

When, like me, you are passionate about your work, your hobbies and time-off interests can be reciprocally informative at the bedside. When not reducing dislocated shoulders or shocking fibrillating hearts, I vicariously report on a sport that captivated me long ago.

As a photographer for the nationally ranked Cornell University wrestling team, I have an opportunity to interact with some of the top athletes and coaches in the country. Their drive, determination, and willingness to sacrifice remind me of my own medical education.

I aimed to become capable of handling any emergency that comes through the door; they strive to prevail over anyone who steps on the mat to earn the national championship. Hence, how they overcome challenges and setbacks is surprisingly relevant to medical education.

I spoke to Damion Hahn, a two-time NCAA champion and a Cornell assistant coach with 6 years of experience educating top wrestling talent to perform against the toughest opponents. If you want to know how to get capable and motivated people to execute complex psychomotor skills in stressful situations, Damion is a great source of practical wisdom.

“What do you tell a wrestler who is having a lot of trouble in the first period so he performs better in the second?” I asked him during this year’s Eastern Intercollegiate Wrestling Association championship that Cornell won for the 6th year in a row.

The answer was incredibly thoughtful. “That depends,” he said.

“If he is getting his doors blown off, berating him will do no good. He knows he is getting handled; he is hurt. To persevere through it, he needs encouragement. I do my best to support him and remind him of the fundamentals he already knows to help him regain confidence and focus. This will help him defend effectively against a superior opponent. There are many lessons worth teaching, but I save them for later, when he is able to absorb them.”

I believe this strategy applies perfectly to teaching clinical medicine. Trainees dealing with a tough challenge cannot absorb and incorporate comprehensive critical feedback. Their emotional state requires support and encouragement, especially because they will need to continue performing under stress immediately after receiving feedback. Yet pure emotional support may be seen as a patronizing gesture to medical students and residents accustomed to learning from adversity.

A reminder of familiar fundamentals both constructively refocuses them on the task and reassures them that they already have what it takes to overcome the challenge. I could sum it up in a catchphrase: “When the problem is mental, keep it fundamental!”

Coach Hahn wasn’t done. “If the wrestler is doing OK after the first period, he just needs a nudge in the right direction. I remind him he can still win it and give one or two tips. Again, there is much I can say, but it’s the wrong time. I have to keep it short and sweet if I expect him to use any of it in the second period.” The distinction was key. A demoralized trainee demolished by the circumstances needs emotional support and reassuring fundamentals.

A competent performer benefits from encouragement and limited, focused feedback.

So the next time you supervise, remember it only takes seconds to coach effectively and improve subsequent morale and performance. When the problem is “mental,” keep it fundamental. Help them “take the lead” with short and sweet. Be generous with encouragement and enjoy their triumphs. They are also yours.

Dr. Veysman is an assistant professor and attending physician in the Department of Emergency Medicine at the University of Medicine & Dentistry, New Jersey Robert Wood Johnson Medical School.

Note From Dr. Veysman: “Whatever you do, it takes about a decade to become an expert. At my 10-year mark in emergency medicine I see myself having become proficient and efficient, yet I also discovered challenges that persist despite all the study and experience. Knowing there is so much more to discover both grounds and thrills me. Join me in this column on a journey to keep improving. Akin to your next patient, the next thing you learn may just surprise you. As the saying goes, “don’t get bitter, just get better.” It may be the most constructive approach to challenges and frustrations of our work and a path to career-long satisfaction, resilience and adaptability. Let’s go.“