The medical field is a profession filled with feedback devices. Some are "coupled" - that is, the system automatically responds to feedback signals by making changes. A thermostat is one familiar example of this. However, many feedback devices merely provide a medical student with information. It is up to him or her to interpret that information and to decide how to use it.

It is vital that a medical student develop these skills after USMLE Step one, much better if these skills are already present as part of his personality. This will not only prevent conflicts or misunderstandings in an in-house USMLE review but also an added asset for anyone who will be in frequent interaction with ill people. Do you already have the skills of providing effective feedback? You do if:

• you describe the behavior which led to the response

• your response comes as soon as appropriate after the behavior – immediately if possible, later if events make that necessary

• your response is direct, from you to the other person or vice versa

• you use "I" messages and takes responsibility for your thoughts, feelings, and reactions

• you include the other person's real feelings about the behavior, in so far as it is relevant to the feedback

• you check for clarity, to ensure that the other person or receiver of the information fully understands what is being conveyed

• you ask relevant questions which seek information with the receiver knowing why the information is sought and having a clear sense that you do not know the answer

• you specify consequences of the behavior – present and future

• your feedback is solicited or at least to some extent desired or asked by the receiver

• your statement refers to the behavior about which the receiver or the other person can do something

• you take into account the needs of the other person, that communication is a process and that you may be receiving information from him as much as you are providing information now

• you affirm the other person's existence and worth by acknowledging his or her right to have the reactions he or she has, whatever they may be, and by being willing to work through issues in a game-free way

Telling your colleague that you'd rather finish the USMLE review session than to go to the baseball game is not feedback. It's just information. Effective feedback is information that can be heard by the receiver that keeps the relationship intact, open, and healthy and that validates the feedback process in future interactions. Further, feedback does not assume that the giver is totally right and the receiver wrong. Instead, it is an invitation to interaction and has some give-and-take to it. Also, it is behavior that is inappropriate in interactions with people who do not have the same significance in one's life, otherwise termed as "rumor."