The Receiver of Feedback and Simulation Pedagogy

By: Sabrina Beroz

As health care educators in academia, practice, and industry, we learn how to give feedback. Rarely do we learn about receiving feedback. This blog brings insight into feedback as discussed in Thanks for the Feedback: The Science and Art of Receiving Feedback Well by Douglas Stone and Sheila Heen. According to the authors, receiving feedback can be taught and refined, whether the feedback is formal or informal, explicit or implicit.

Feedback happens many times during the course of a day and is foundational to learning and growth. The receiver holds the cards. choosing whether to accept the feedback and how to react. Feedback sits at the crossroads of two basic human needs – wanting to improve and wanting to be accepted.

Stone and Heen’s book identifies three triggers and challenges that impact how we react to feedback. There are Truth Triggers (the challenge of SEE), Relationship Triggers (the challenge of WE), and Identity Triggers (the challenge of ME). Note how these triggers align with simulation pedagogy.

The Receiver of Feedback and Simulation Pedagogy graphic1

Truth triggers are how we SEE feedback when differentiating feedback according to our expectations – whether we expect appreciation, coaching, or evaluation.

  • Did we expect appreciation and receive evaluation? Or did we expect evaluation and receive coaching? Often, coaching is misinterpreted as evaluation.
  • The INACSL Standard of Best Practice: Participant Evaluation (2016) addresses the difference in feedback for formative, summative, or high-stakes evaluation. The participant must be aware of the level of evaluation prior to a simulation experience.
  • Formative evaluation provides facilitated feedback (debriefing) in meeting objectives (appreciation and coaching).
  • Summative and high-stakes evaluation measures competence with higher level consequences for the participant (evaluation).

In the challenge of SEE, receivers of feedback need to identify blind spots – how we see ourselves versus how others see us. Simulation theory addresses blind spots using adult learning principles and recognition of the influence of mental models on the relationship between the facilitator and participant.

Relationship triggers are how we see the feedback within our relationship with the person giving the feedback. This is the challenge of WE. The authors talk about the concept of switch-tracking when the internal discussion is different (often judgmental) from the external feedback.

  • The principles of reflective practice in simulation-based education provide guidance in questioning assumptions in order to respectfully understand the thinking behind actions of the participant in a scenario (Rudolph, Simon, Rivard, Dufresne, & Raemer, 2007).
  • Modeling the behavior of receiving feedback can be a useful teaching tool, enabling participants to learn how to receive feedback well.
  • The Center for Medical Simulation (2017) answers the challenge of WE with the basic assumption: “We believe that everyone … is intelligent, capable, cares about doing their best and wants to improve” (p.TM1). Both facilitators and participants hold the basic assumption of one another and themselves.

Identity triggers look at the challenge of ME and how wiring, temperament, and distortions impact feedback. Three key variables drive sensitivity to feedback:

  • Baseline is the set point for holding on to a positive or negative feeling.
  • Swing is how far you swing with positive or negative feedback.
  • Sustain and recovery is how long you hang on to positive or negative feedback and recover to baseline.

The authors also discuss Google Bias in the challenge of ME as how the receiver supersizes feedback to aspects outside the original discussion.

  • Simulation utilizes the concept of psychological safety to manage the challenge of ME.
  • The INACSL Standard of Best Practice: Simulation for Debriefing requires an environment “conducive to learning and supports confidentiality, trust, open communication, self-analysis, feedback and reflection” (INACSL, 2016, p. S22).

In conclusion, being aware of the challenges of SEE, WE, and ME enhances the facilitator/participant relationship and clarifies expectations and personal identity. We want our participants to be able to take interpersonal risk in the service of learning while receiving meaningful feedback.


Center for Medical Simulation. (2017, October 23-27). Institute for Medical Simulation comprehensive instructor course handbook. Boston, MA: Author.

International Nursing Association for Clinical Simulation and Learning. (2013). Standards of best practice: Simulation. Clinical Simulation in Nursing, 9(Suppl.), S1-S32.

Rudolph, J.W, Simon, R., Rivard, P., Dufresne, R., & Raemer, D. (2007). Debriefing with good judgment: Combining rigorous feedback with genuine inquiry.  Anesthesiology Clinics, 25, 361-376.

Stone, D., & Heen, S. (2014). Thanks for the feedback: The science and art of receiving feedback well. New York, NY: Penguin Random House.

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