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Criticism, praise, and professional growth
ED TOR AL
Cr t cism, Praise, and Profess anal Growth After attending a nursing research conference, I was forced to reflect on our reluctance to evaluate and criticize our colleagues' work. Although many participants gave vague and nonspecific feedback about the "importance" of the research that had been presented, few specific or critical comments were offered. I have played the roles of participant and presenter as an author and conference faculty, and I am well aware of the trepidation caused by facing your peers and receiving criticism for work that represents your toil, sweat, and tears. I am convinced, however, that the lessons and insights gained from critical as well as from positive feedback play an essential role in my academic growth by motivating me to validate or discard assumptions about my practice, reevaluate popular dogma, and avoid meaningless and selfcongratulatory pats on the back.
THE VALUE OF CRITICISM Although I recognize that the novice should learn from a "cookbook" approach and highly structured evaluation, I cannot support the notion that the experienced clinician-researcher should not be exposed to critical review of her or his work, and of the beliefs that comprise current practice. In contrast, I argue that restraint from criticism limits the value of an article or of a podium or poster presentation, and reduces a format designed for academic growth and learning to a monolog. I once presented a new variation of a urodynamic technique. I was proud of the technique, and of its ability to predict renal function changes in a particular group of patients. After my presentation of this research, however, I was asked w h y my colleagues should adopt this technique when a simpler technique gave similar predictive power. I promptly responded that the data from m y technique showed greater statistical power to predict patient outcome. "Yes," my colleague responded, "But does it make any difference in clinical management?" I was dis-
appointed, but I also realized (after additional reflection) that he was correct. Why investigate and advocate a complex technique prone to artifact when a simpler test provides equivalent results? Without his insightful criticism, I would have pursued investigation of this technique, and I probably would have demonstrated its potential application to a broader range of patients. It is extremely unlikely, however, that I would have overcome the fundamental limitation of the technique. Although the process of enduring his criticism was unpleasant after a stressful presentation at a scientific meeting, the outcome was far more valuable that any discomfort I experienced during the process. Whether you are a clinician or a researcher, I submit that you have an obligation both to seek criticism of your assumptions, techniques, and judgments and to critically evaluate those embraced by your colleagues. When you actively seek criticism of your clinical or investigational work, you open yourself to the insights, wisdom, and folly of your peers. Although this process may seem unpleasant, it will protect you from the deadly trap of complacency, and from the assumption that expertise confers correctness. When you criticize the work of others, you endow the work of your colleagues with significance. Criticism demonstrates that you have listened to or read their work, that you have carefully considered its significance, and that you are actively reconsidering your practice because of their work. Although I am advocating more open debate concerning the clinical and investigational techniques, judgments, and assumptions that comprise nursing practice, I am not promoting argument as its own reward. The purpose of academic criticism is to provide an opportunity for learning, not simply a forum for dissent.
THE INFORMED CRITIC Constructive, academic criticism is never a blind attack on the ideas of a colleague. Rather, it is a carefully con-
Mikel Gray, PhD, CUNP, CCCN, FAAN
J WOCN 1996;23:63-5 Copyright© 1996 by the Wound, Ostomy and Continence Nurses Society. 1071-5754/96 $5.00 + 0 21/9/70454
63
JWOCN March 1996
64 Gray
structed argument pointing out the weaknesses of a technique, conclusion, or assumption. When you read an article or listen to a presentation and disagree with some portion of the presenter's work, it is easy to conclude that he or she is simply wrong. Such a conclusion, however, does not comprise a constructive criticism of the work. Instead, you must review the work, carefully identify the points at which you disagree, and formulate meaningful feedback. When presenting critical feedback, I advise using several techniques to maximize the impact of your insights while removing the perception of a personal attack. Criticize the data, technique, judgment, or assumption, but never the individual. Personal attacks are destructive and stifle learning, whereas probing questions and observations about specific points in a presentation offer an opportunity for growth and learning. I suggest limiting your questions or observations to one or two important points. These comments should be stated assertively, but they must acknowledge the broader value of the author's work or research. For example, you may disagree with a technique or conclusion used by a researcher, but you should state these concerns in the context of the importance to nursing practice of the investigation, article, or presentation. Remember that even relatively weak research may offer initial insights into a question about which we have little or no knowledge, and expert opinion may be the only insight we have as we attempt to manage a complex clinical situation. Be specific when offering critical feedback. Suppose you disagree with one or more conclusions a researcher has reached. Rather than simply stating that you do not agree with the research, consider which step in the research process led to the conclusion that you are questioning. You may disagree with the technique used to collect the data, the choice of subjects, the time at which outcome data were collected, or the statistical analysis employed to reach a certain conclusion. By identifying or questioning the step in the research process that caused your concern, you are offering the researcher an opportunity to reevaluate the data, rather than simply dismissing the work as "wrong." Similarly, when criticizing an opinion or conclusion reached by an expert clinician, focus on specific points
that cause concern. This helps the presenter and others to identify areas of controversy, at the same time avoiding a misperception that the expert's judgment can be broadly labeled as "wrong" or "right."
SEEKING AND ACCEPTING CRITICISM Although it may be difficult to provide criticism, it is even harder to seek out and accept criticism from colleagues. When presenting at a meeting or publishing an article, I am thrilled to hear positive feedback but I also attempt to seek out critical input. Although I wish that m y work could be "beyond reproach," I remind myself that the negative comments I hear frequently help me to improve m y understanding of a problem, reevaluate the techniques I use in m y practice, and challenge assumptions that underlie clinical judgments and decisions. Specific coping strategies are helpful when handling criticism. When presenting at a conference or after publication of an article I find it easy to be hurt or stung by criticism, but I have found that this response limits my ability to adequately respond to or learn from others' feedback. Initially, I attempt to categorize the criticism as personal or well reasoned. I manage personal criticism by thanking the person for the comments (in person or in writing) but declining to respond further. This helps me to avoid becoming angry or hurt and saves my energy for more important, substantive feedback. When I hear or read substantive feedb a c k I concentrate on understanding the point or argument. If I am presenting material at a conference, I personally thank the person for the feedback and as soon as possible write down the most important points he or she has raised. I do not try immediately to refute these arguments; rather, I reflect on them after the pressure is off. If I believe that the person has raised a significant point, I either seek him or her out for further feedback or seek to disprove the argument. When I am able to disprove an argument, I feel more confident that my approach and beliefs are correct. When I am unable to disprove an argument, I am challenged to reevaluate my current practice, and to investigate w h y I was wrong.
JWOCN Volume 23, Number 2
CRITICISM VERSUS PRAISE Although I have focused on critical feedback, I must emphasize that I am not arguing that we should reduce our praise for our colleagues' work. I strongly believe that it is equally important to offer carefully considered praise and thoughtful criticism. As with the critical comment, I have found that my knowledge and skill have been strengthened when a
Gray 65
colleague or mentor has pointed out a maturation in my clinical judgment, my research, or my style of presentation. What I am arguing is that the silence of apathy and hollow praise without critical reflection must be replaced with careful evaluation of our written or oral presentations. Through praise we gain confidence; through constructive criticism we gain insight--through silence we learn only complacence.
INTENT TO SUBMIT If you would like to have an abstract, a detailed outline, or a manuscript reviewed for possible publication, please complete this form and return it to the Editor. Check all that apply: [] I would like to submit the attached manuscript for possible publication ~ . i n the Wound Care section, Ostomy Care section, or _ _ C o n t i n e n c e Care section. (Check one). [] I would like to submit my manuscript for possible publication in Options in Practice. [] I would like to talk with the _ _ . ( s p e c i f y ) Section Editor. I will be ready to submit my manuscript by
(date).
Topic or manuscript title:
Name Moiling address Telephone Fax Please indicate the best time to reach you
Send to: Mikel Gray, PhD, CUNP, CCCN, FAAN, Editor, JOURNALOF WOCN, 1391 Delta Corners, Lawrenceville, GA 30245; phone 770-978-0748. See Information for Authors in each issue for details on manuscript specifications, submission procedures, and the peer-review process. An author information packet will be mailed to you on receipt of this form.
Cr t cism, Praise, and Profess anal Growth After attending a nursing research conference, I was forced to reflect on our reluctance to evaluate and criticize our colleagues' work. Although many participants gave vague and nonspecific feedback about the "importance" of the research that had been presented, few specific or critical comments were offered. I have played the roles of participant and presenter as an author and conference faculty, and I am well aware of the trepidation caused by facing your peers and receiving criticism for work that represents your toil, sweat, and tears. I am convinced, however, that the lessons and insights gained from critical as well as from positive feedback play an essential role in my academic growth by motivating me to validate or discard assumptions about my practice, reevaluate popular dogma, and avoid meaningless and selfcongratulatory pats on the back.
THE VALUE OF CRITICISM Although I recognize that the novice should learn from a "cookbook" approach and highly structured evaluation, I cannot support the notion that the experienced clinician-researcher should not be exposed to critical review of her or his work, and of the beliefs that comprise current practice. In contrast, I argue that restraint from criticism limits the value of an article or of a podium or poster presentation, and reduces a format designed for academic growth and learning to a monolog. I once presented a new variation of a urodynamic technique. I was proud of the technique, and of its ability to predict renal function changes in a particular group of patients. After my presentation of this research, however, I was asked w h y my colleagues should adopt this technique when a simpler technique gave similar predictive power. I promptly responded that the data from m y technique showed greater statistical power to predict patient outcome. "Yes," my colleague responded, "But does it make any difference in clinical management?" I was dis-
appointed, but I also realized (after additional reflection) that he was correct. Why investigate and advocate a complex technique prone to artifact when a simpler test provides equivalent results? Without his insightful criticism, I would have pursued investigation of this technique, and I probably would have demonstrated its potential application to a broader range of patients. It is extremely unlikely, however, that I would have overcome the fundamental limitation of the technique. Although the process of enduring his criticism was unpleasant after a stressful presentation at a scientific meeting, the outcome was far more valuable that any discomfort I experienced during the process. Whether you are a clinician or a researcher, I submit that you have an obligation both to seek criticism of your assumptions, techniques, and judgments and to critically evaluate those embraced by your colleagues. When you actively seek criticism of your clinical or investigational work, you open yourself to the insights, wisdom, and folly of your peers. Although this process may seem unpleasant, it will protect you from the deadly trap of complacency, and from the assumption that expertise confers correctness. When you criticize the work of others, you endow the work of your colleagues with significance. Criticism demonstrates that you have listened to or read their work, that you have carefully considered its significance, and that you are actively reconsidering your practice because of their work. Although I am advocating more open debate concerning the clinical and investigational techniques, judgments, and assumptions that comprise nursing practice, I am not promoting argument as its own reward. The purpose of academic criticism is to provide an opportunity for learning, not simply a forum for dissent.
THE INFORMED CRITIC Constructive, academic criticism is never a blind attack on the ideas of a colleague. Rather, it is a carefully con-
Mikel Gray, PhD, CUNP, CCCN, FAAN
J WOCN 1996;23:63-5 Copyright© 1996 by the Wound, Ostomy and Continence Nurses Society. 1071-5754/96 $5.00 + 0 21/9/70454
63
JWOCN March 1996
64 Gray
structed argument pointing out the weaknesses of a technique, conclusion, or assumption. When you read an article or listen to a presentation and disagree with some portion of the presenter's work, it is easy to conclude that he or she is simply wrong. Such a conclusion, however, does not comprise a constructive criticism of the work. Instead, you must review the work, carefully identify the points at which you disagree, and formulate meaningful feedback. When presenting critical feedback, I advise using several techniques to maximize the impact of your insights while removing the perception of a personal attack. Criticize the data, technique, judgment, or assumption, but never the individual. Personal attacks are destructive and stifle learning, whereas probing questions and observations about specific points in a presentation offer an opportunity for growth and learning. I suggest limiting your questions or observations to one or two important points. These comments should be stated assertively, but they must acknowledge the broader value of the author's work or research. For example, you may disagree with a technique or conclusion used by a researcher, but you should state these concerns in the context of the importance to nursing practice of the investigation, article, or presentation. Remember that even relatively weak research may offer initial insights into a question about which we have little or no knowledge, and expert opinion may be the only insight we have as we attempt to manage a complex clinical situation. Be specific when offering critical feedback. Suppose you disagree with one or more conclusions a researcher has reached. Rather than simply stating that you do not agree with the research, consider which step in the research process led to the conclusion that you are questioning. You may disagree with the technique used to collect the data, the choice of subjects, the time at which outcome data were collected, or the statistical analysis employed to reach a certain conclusion. By identifying or questioning the step in the research process that caused your concern, you are offering the researcher an opportunity to reevaluate the data, rather than simply dismissing the work as "wrong." Similarly, when criticizing an opinion or conclusion reached by an expert clinician, focus on specific points
that cause concern. This helps the presenter and others to identify areas of controversy, at the same time avoiding a misperception that the expert's judgment can be broadly labeled as "wrong" or "right."
SEEKING AND ACCEPTING CRITICISM Although it may be difficult to provide criticism, it is even harder to seek out and accept criticism from colleagues. When presenting at a meeting or publishing an article, I am thrilled to hear positive feedback but I also attempt to seek out critical input. Although I wish that m y work could be "beyond reproach," I remind myself that the negative comments I hear frequently help me to improve m y understanding of a problem, reevaluate the techniques I use in m y practice, and challenge assumptions that underlie clinical judgments and decisions. Specific coping strategies are helpful when handling criticism. When presenting at a conference or after publication of an article I find it easy to be hurt or stung by criticism, but I have found that this response limits my ability to adequately respond to or learn from others' feedback. Initially, I attempt to categorize the criticism as personal or well reasoned. I manage personal criticism by thanking the person for the comments (in person or in writing) but declining to respond further. This helps me to avoid becoming angry or hurt and saves my energy for more important, substantive feedback. When I hear or read substantive feedb a c k I concentrate on understanding the point or argument. If I am presenting material at a conference, I personally thank the person for the feedback and as soon as possible write down the most important points he or she has raised. I do not try immediately to refute these arguments; rather, I reflect on them after the pressure is off. If I believe that the person has raised a significant point, I either seek him or her out for further feedback or seek to disprove the argument. When I am able to disprove an argument, I feel more confident that my approach and beliefs are correct. When I am unable to disprove an argument, I am challenged to reevaluate my current practice, and to investigate w h y I was wrong.
JWOCN Volume 23, Number 2
CRITICISM VERSUS PRAISE Although I have focused on critical feedback, I must emphasize that I am not arguing that we should reduce our praise for our colleagues' work. I strongly believe that it is equally important to offer carefully considered praise and thoughtful criticism. As with the critical comment, I have found that my knowledge and skill have been strengthened when a
Gray 65
colleague or mentor has pointed out a maturation in my clinical judgment, my research, or my style of presentation. What I am arguing is that the silence of apathy and hollow praise without critical reflection must be replaced with careful evaluation of our written or oral presentations. Through praise we gain confidence; through constructive criticism we gain insight--through silence we learn only complacence.
INTENT TO SUBMIT If you would like to have an abstract, a detailed outline, or a manuscript reviewed for possible publication, please complete this form and return it to the Editor. Check all that apply: [] I would like to submit the attached manuscript for possible publication ~ . i n the Wound Care section, Ostomy Care section, or _ _ C o n t i n e n c e Care section. (Check one). [] I would like to submit my manuscript for possible publication in Options in Practice. [] I would like to talk with the _ _ . ( s p e c i f y ) Section Editor. I will be ready to submit my manuscript by
(date).
Topic or manuscript title:
Name Moiling address Telephone Fax Please indicate the best time to reach you
Send to: Mikel Gray, PhD, CUNP, CCCN, FAAN, Editor, JOURNALOF WOCN, 1391 Delta Corners, Lawrenceville, GA 30245; phone 770-978-0748. See Information for Authors in each issue for details on manuscript specifications, submission procedures, and the peer-review process. An author information packet will be mailed to you on receipt of this form.