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Everyone needs a shit sandwich!

Leadership, instruction, coaching, mentorship all of these processes require feedback. A well known tool for feed back is affectionately called the "shit sandwich". There seems to be a fair amount of animosity towards this process of giving feed back. It is my experience from providing leadership training either through running instructor courses, training guides, or precepting aspiring paramedics. When the topic of how to give feed back, the shit sandwich is often defined as not authentic.

For anyone reading this who doesn't know what the shit sandwich is, it is the process of giving constructive feed back to those you are training or coaching. In the analogy of the sandwich the bread is the good stuff, complements, accolades, etc. The shit is the meat and cheese, peanut butter and jam or the substance of the "constructive part"; where improvements can be made, or even highlighting failures in performance. So to make a sandwich you would start your feedback with "hey you have done very well with this and this, but you need improvement on this and that, you have shown improvement overall on so and so"

I think the disconnect with this process is how inevitably inadequate the bread is, how thin the bread is or that the sandwich more or less, becomes a wafer. Also when giving feed back typically people are hard wired to only hear the criticisms. In fact we can spend our lives gaining complements 95% of the time and its the one piece of negative feed back and that one poor report suddenly defines our whole being. For example, I am constantly looking for reassurance and validation. I do suffer from imposter syndrome and reading course evaluations that come back from students is often where I find validation. I have stacks of course evaluations where I score highly as an instructor, however there has been a couple where my score as an instructor was very low. Now, what evaluation has resonated and stayed with me? You guessed it, the evaluation that was very critical or negative. Naturally I had to remind my self that I have been teaching technical courses for almost 20 years and I can't let one or two poor reports actually define my abilities. Rather, that I should be thankful for some real details that I can use to improve on.

When I take on a new paramedic student it is customary to sit down and review the expectations of their practicum. How best we can work together and progress over the time we have. EMS is stressful, there has been many students that have made it through school only to fail their practicums. This is where the rubber meets the road. Where a student is pressed into applying their knowledge and eventually see a call through in its entirety. It is said that you should only pass a student you feel comfortable to treat your own family. Naturally a high standard. Imagine trying to improve as a student in this environment without being able to take feed back well. This is the expectation, to take feedback as it is given. One of the criteria in getting along in the student/preceptor relationship is assimilating feedback. The student cannot get defensive with the details of their required improvement. This is a candid conversation where the student is supported in the idea that there may be disappointment and feelings of personal failure but also that the student cannot focus in the negative emotions and give themselves permission to make mistakes. However there can not be any guilt or personal disapproval but that they need to be resilience. This will ensure they can learn from every misstep and take feedback with a positive outlook.

This is the secrete to providing the bread to the sandwich. The student needs to eat the bread. That the positive feed back that is given is actually regarded and applied to their own ego. The student needs to be coached on how to take a complement. I sometimes start a specific skills session reminding students that they need to hear and apply the complements they receive. Next, the bread needs to be specific and detailed. Make it thick and give it lots of ingredients. Give the student props for specific things they did well and ask them if they felt it, or can see how there was improvement or success. Your students are not going to connect with a shit sandwich when they hear "that was good, but you can improve by doing this and that" rather try "ok, nice work! I really like how you applied this principle. Did you see how well it worked for you? And you also did very well in connecting to this effort as well". That's a good slice of bread right there. Now that some positive feed back is applied and the student has been directed to connect with it there can be a transition into the constructive feedback.

The shit part of sandwich as the constructive feedback doesn't have to be negative. In fact it can be an extension of the bread. If there is something specific that the group or individual is working on can be delivered in a way where the successes have been identified can be built on. Also, that an excitement of anticipation to getting the skill or completing the challenge is facilitated. I have found where there is an expectation and accountability is required (mostly in the context of a paramedic student or my own children's poor choices) where there is anticipation of negative feelings, that the student is reminded of their own responsibility to learn from the failure rather than wallow in self pity. Guilt needs to be avoided completely however negative feelings need to be allowed to be processed.

A true sandwich requires two slices of bread. Rehashing the same positive feedback can help reinforce those accolades, however this can also be an opportunity build up the excitement for another try. Review a plan for success either with the same plan as before or with new strategies or benchmarks. In an effort in being concise and not talking too much there can be brief expression of approval for the discussion and efforts overall.

So the "Shit Sandwich" isn't so much a sandwich but a flow from positive feedback, to connection to strategies to improve or failure realization, then to building a plan to move forward and improve. And lastly, a facilitation of asserting the positive feelings that come from moving through the process. Naturally the outcome is the goal, but true performance comes from maintaining development and the dopamine hit from every small victory. Overall the student or group needs to be coached and on how to be coached. Groups and students need support to be able to receive constructive feed back without being defensive. This is a win in its self.

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