Filling the feedback gap: the unrecognised roles of shame and guilt in the feedback cycle

I was halfway through a recent feedback session with Dr W, a firstyear resident on our in-patient service, when things began to unravel. His eyes, heavy and focused on the floor, suggested inner turmoil in response to what I felt was constructive, albeit challenging, feedback. He shifted uncomfortably in his chair and was visibly disturbed. Things escalated at the conclusion of our conversation: ‘I appreciate everything you told me but I just don’t think I’m good enough to get through residency. I have too many deficiencies, I feel like an impostor, and honestly, I’m thinking about quitting.’