Feedback a surgeon will accept

01

Why feedback to surgeons usually fails

It fails because it is not feedback. It is an opinion with a reporting line behind it.

Somebody in operations reads a complaint, forms a view, waits for the quarterly meeting and opens with the word concerns. The surgeon asks which case. The answer is general. The surgeon asks which standard. There is not one written down, only a sense that this is not how we do things. At that point the conversation is about status, and the surgeon wins it, because they were in theatre and you were not.

The interesting part is that surgeons are not the obstacle people assume. Surgical Endoscopy published an international survey of 521 surgeons across 39 countries on peer coaching. Willingness to take part ran at 84 percent, while only around 30 percent regularly sought structured peer feedback. The barriers surgeons named were mostly practical. Scheduling and logistics led at 68 percent. Fear of appearing unskilled was named by 10 percent and competition with colleagues by 13 percent. The same survey recorded what surgeons wanted the feedback to look like: private, confidential, from a colleague they already knew, tied to goals they had set themselves.

Read that list again. Almost none of it concerns the content of the feedback. All of it concerns the conditions under which it arrives. Most organisations get the conditions wrong and then conclude that surgeons do not take feedback.

Feedback a surgeon can argue with is not feedback. It is a difference of opinion with a reporting line attached.

02

Agree the standard before the case, not after

This is the single change that does the most work, and it costs nothing except one difficult month.

Write the standard first. What must be documented, by whom, within how long. What the acceptable band is for anything you intend to measure. What counts as a complication that has to be reported rather than managed quietly. Then take it to the people it applies to and let them argue with it, hard, before any of their cases are in scope. Change what they are right about. Publish it with a version number and a date.

After that, every review conversation has a different shape. You are not asserting that something was wrong. You are putting a case and a document the surgeon has already agreed to side by side, and asking them to reconcile the two. If they can, you have learned something about your standard. If they cannot, they know it before you say it.

A standard written after the case is prosecution. The same words written before it are a shared reference. Completely different conversation.

03

The four line brief

This is the format I use. It fits on half a page. Four lines, in this order, for one case.

One, the case. A single identifiable record with a date and a reference, not a pattern, not several cases summarised into a theme. Patterns come later, once single cases have been accepted one at a time.

Two, the standard. The exact line from the published document, quoted, with its version number. Not a paraphrase, and not your reading of the spirit of it.

Three, the gap. What the record shows set against what the standard requires, in observable terms. The photograph set has four of the six required views. The operative note names the surgeon but not the assistant. Nothing about competence, nothing about attitude, nothing you cannot point at on a page.

Four, the ask. One change, one date, one way it will be visible. Not a list of improvements. One.

Anything that will not fit those four lines is not ready to be said yet. Saying it anyway is how a review programme spends the credibility it will need for the case that actually matters.

04

Who says it decides whether it lands

The technical conversation should come from someone who operates.

JAMA Surgery reported on a group based peer coaching intervention among practising surgeons, run partly because one to one coaching pairs left participants uncomfortable in the coachee role even when the roles were assigned at random. The authors made the point plainly: perceived hierarchy dampens receptiveness, and a group format spreads the authority out.

Surgery published a study of coaching conversations between bariatric surgeons reviewing each other's operative video. The assigned roles did not hold. Coaches admitted gaps in their own experience and asked to be taught. The exchange ran both ways, and it worked because nobody sat above anybody.

Academic Medicine has published a facilitated feedback model built on four moves in sequence: build the relationship, explore the reaction, explore the content, then coach for change. The order is the useful part. Most managers open at content and are then surprised when the reaction turns up anyway.

None of this removes the manager. You still own the standard, the record, the date and the consequence. What you should not own is the sentence about how the operating was done.

05

What to do when the answer is no

Disagreement is information, and it arrives in three kinds. Sort it before you respond.

The record is wrong. Something was done and not written, or written somewhere nobody looked. Fix the record, then fix whatever made the record unreliable, because it will not have been one case.

The standard is wrong. The surgeon is telling you the document does not describe good practice in this situation. This is the most valuable answer you can get and the one most often mistaken for resistance. Take it to whoever owns the standard, in writing, with the case attached, and be seen to change it.

The standard is right and the surgeon does not accept it. That is no longer a feedback problem. It is a governance decision, and it belongs with contracts and credentialling rather than with a better conversation. Pretending otherwise costs a year.

06

What is yours and what is not

You do not control whether a surgeon agrees with you, respects your role, changes technique, or walks out thinking well of you. Anyone selling a method that guarantees those things is selling something else.

What is yours is everything either side of the meeting. The standard written and argued over in advance. The record complete enough to be checked by someone who was not there. Who delivers the conversation. The privacy it happens in. The single ask, the date attached to it, and your own willingness to be shown that the document was wrong. Then the part most organisations skip: what actually happens when the date passes and nothing has moved.