Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Alicia DiGiammarino, an expert in health professions education innovation and research, discusses her KevinMD article, “Transform feedback into growth with the ARISE model.” Alicia explores how the ARISE model—Ask, Receive, Interpret, Set next steps, and Express gratitude—provides a structured approach to receiving and applying feedback effectively. She highlights the psychological barriers like the amygdala hijack that make feedback challenging and offers actionable strategies to navigate these reactions. The conversation emphasizes fostering open communication, building resilience, and leveraging feedback to enhance teaching, mentorship, and patient care.
Our presenting sponsor is DAX Copilot by Microsoft.
Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Alicia DiGiammarino. She specializes in health professions education, innovation, and research. Today’s KevinMD article is “Transform feedback into growth with the ARISE model.” Alicia, welcome back to the show.
Alicia DiGiammarino: Thank you.
Kevin Pho: All right. So let’s jump straight into your most recent KevinMD article. But before talking about that, what led you to write it in the first place?
Alicia DiGiammarino: Last fall, we at the Teaching and Mentoring Academy at Stanford School of Medicine conducted a giving feedback workshop, and the formal content got completely derailed by personal stories about how challenging receiving input can be. We’ve really been hearing more and more from faculty and students who struggle with—or are completely avoiding—feedback conversations.
That’s troubling, given that medical education is built on an apprenticeship model in which more experienced clinicians help trainees build competency over time, in a patient care setting. We’ve been working on developing a tool to help people structure their response to feedback, allowing them to reflect on and build that skill. We also developed a workshop on receiving feedback that we’re now delivering, and we’re getting very positive feedback on it. Having a tool, like the model in the article, can provide that structure in the moment and help people reflect on and improve their skills in receiving feedback.
Kevin Pho: All right. And before talking about that model, let’s go deeper in terms of the role of feedback in medical training. You likened it to an apprenticeship model, where feedback is critical to that. From the medical students, residents, and interns that you encounter, what is the role of feedback in their growth?
Alicia DiGiammarino: I would say that people should—and sometimes do and sometimes don’t—receive feedback all day, every day, as they learn how to do procedures, communicate with patients, and so on. I recently read a 2024 study in BMC Medical Education called “The feedback dilemma in medical education,” and the authors found that 78 percent of residents agree that feedback improves clinical performance, but only 25 percent report receiving regular feedback. They may not be recognizing it when it happens, but that’s still a strikingly low number of people who feel they get feedback regularly. Of course, if you think back on your own training, feedback is so important for developing skills and knowledge.
Kevin Pho: All right. So tell us about your article and the model you want to introduce.
Alicia DiGiammarino: Yes. The model is called the ARISE—aim to receive feedback—model, and it’s an acronym that stands for Ask, Receive, Interpret, Set next steps, and Express gratitude. I can walk you through the steps:
- A (Ask): Here you take the initiative. Ask yourself what kind of help you need and who you need it from, then ask for feedback. We grow as clinicians and educators by stretching outside our comfort zone and asking for feedback from multiple sources.
- R (Receive): I like to say that feedback is a gift because giving feedback is very, very hard. Actively listening as you receive it shows respect to the giver and allows you to take it all in. At this point, you might note your immediate response—do you feel angry, sad, defensive? Once you identify how you feel, you can choose your next steps rather than proceeding on autopilot. I like to say you can actively select a mindset of curiosity.
- I (Interpret): This step is so important and easily skipped. Rather than responding right away, give yourself time to absorb the feedback and reflect on what it means and how it sits with you. Ask yourself what feels right about it and what you disagree with.
- S (Set next steps): Now you’ve heard the feedback and thought about it. You get to decide how to use it. You might even write down what you’re going to do with the feedback. Also consider how you did in receiving it—what went well, and what could have gone better?
- E (Express gratitude): As I said, it’s almost as hard to give feedback as it is to receive it. Ideally, you take a moment to thank the person for their thoughts.
Kevin Pho: Using this structured model, how does that contrast with a traditional way of giving feedback, perhaps without a guide like this?
Alicia DiGiammarino: What happens a lot is that people think about feedback and focus on the giving aspect. What we’ve realized is there’s another side to the puzzle: the receiving end. The receiver also has responsibility for turning feedback into a productive conversation. This model gives the receiver structure so they can follow a step-by-step process to receive feedback and build that skill by reflecting on how they did. Eventually, the idea is you let go of the model and just do it on your own. But like anything in medicine—where we have so many acronyms—you need time to learn the skill and become competent.
Kevin Pho: So tell us the outcomes after implementing a model like this.
Alicia DiGiammarino: Ideally, learners and educators develop better rapport, take in more knowledge, and feel they can advance in their skills more quickly. At the Teaching and Mentoring Academy, we’ve been getting extremely positive feedback on our new workshops based on this model. People say it provides a chance to think about something they hadn’t fully considered before. We’re excited to keep advancing this, and we’re working on a series about feedback that covers giving feedback, receiving feedback, and challenging conversations, culminating in a day dedicated to practice.
Kevin Pho: It sounds like giving and receiving feedback needs to be formally taught. Is that happening at Stanford among medical students and future clinicians?
Alicia DiGiammarino: That’s a good question. We have quite a bit of coverage around feedback at various levels, though I’m not sure if it’s fully consistent. In medical education, we’re talking a lot now about the “learning climate,” and there are many definitions of it—but I see it as, “How does it feel to be the learner and the teacher? Do you feel safe and respected? Is the physical and emotional space conducive to learning?” I wonder if the learning climate would improve if across the country, we incorporated formal training on giving and receiving feedback from preclinical trainees all the way to faculty development. It’s not simple to measure how much that would improve the learning climate, but I do think it’s worth exploring.
Kevin Pho: For teachers and clinicians who have to give feedback to students and mentees, what are some tips they can use to give constructive feedback within the confines of this model?
Alicia DiGiammarino: If you want a deeper look at this topic, consider the book Thanks for the Feedback by Douglas Stone and Sheila Heen. A few tips from that book that I love:
- Dismantle distortions. Think about the story you’re telling yourself versus what the feedback actually is. For example, a negative evaluation from a learner might be about that one student’s perspective, not about whether you’re generally likable.
- Think of yourself as a complex being. Avoid an all-or-nothing mindset. You’ll make mistakes, but everyone does. Most people have complex intentions—mostly good, sometimes self-interested—and we all contribute to issues sometimes. Accepting that can ease the pressure.
- Reflect during and after feedback. You can start right now: recall a recent moment you received feedback this week—how did it feel? What did you do well, and what might you do differently next time?
Kevin Pho: Can you share a story or case study of the ARISE feedback model in action? How did it lead to growth, whether real or hypothetical?
Alicia DiGiammarino: Sure. We surveyed participants from our workshops and asked them to share times when receiving feedback was really hard. One person described completing a major project, investing a lot of time and effort, and being excited to present to their team. They expected the team to appreciate the effort, but the team lead instead provided a lot of critical feedback on shortcomings. That person felt blindsided and defensive, saying the feedback felt overwhelming. They struggled with disappointment and frustration.
Here’s where the ARISE model can help. At the “Receive” step, you’d check in with how you’re feeling as the feedback is delivered, naming your emotions so you don’t proceed on autopilot. At the “Interpret” step, you’d ask what the feedback really means—does it mean the entire project was terrible, or are these suggestions for improvement? You can figure out what feels valid and what you might disagree with.
At “Set next steps,” you’d decide how to use the feedback—maybe revise the project or ask follow-up questions. You own this step. Then, at “Express gratitude,” you’d thank the person for their input. It can be as simple as, “I appreciate you taking the time to share this with me.”
Kevin Pho: We’re talking to Alicia DiGiammarino. She specializes in health professions education, innovation, and research. Today’s KevinMD article is “Transform feedback into growth with the ARISE model.” Alicia, what are some take-home messages you want to leave with the KevinMD audience?
Alicia DiGiammarino: I would say that feedback is a cornerstone of medical education, and receiving feedback is incredibly challenging. The receiver shares responsibility for turning feedback into a productive conversation. Having a tool like the ARISE model, outlined in the article, provides structure in the moment and helps people reflect on and improve their skills in receiving feedback.
Kevin Pho: Alicia, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Alicia DiGiammarino: Yeah, thank you. Thanks for having me.
