Judgement is an Emotion: Navigating the Human Complexity of Feedback

"Judgment is an emotion. Every time you articulate a clinical judgment to a colleague, you are delivering an emotional message, whether you like it or not."

In this episode of Better Every Shift, Naomi and Tubi dive into a rich and provocative article by Margaret Bearman et al. titled "Feedback with feelings: the human complexity of expressing judgements about performance." We dismantle the myth that emotions in healthcare are merely "internal psychological states" to be managed in private; instead, we recognize them as the literal "elephant in the room" in every clinical learning environment.

We explore why claiming to give feedback "without judgment" is actually a form of professional dishonesty that can make a situation worse. From the physiological impact of adrenaline and cortisol on our ability to hear properly to the "story" we create in our heads about our peers, this episode provides a roadmap for "naming the edge". Stick around to learn how to move beyond sterile clinical checklists and start having the pragmatic, transparent conversations that actually move the needle on performance.

Key Discussion Points

The Myth of the "Internal State": Why the literature is misleading when it suggests emotions are only the individual's problem to manage.

Judgment as an Emotional Act: Understanding that expressing a judgment is an emotional event for both the supervisor and the trainee.

The Honest Debrief: Why admitting you are upset about a poor outcome can actually lead to a more useful conversation than pretending there is no problem.

Physiological Barriers: How high-stress triggers (like a pager going off) flood the body with chemicals that make it impossible to process complex conversations.

The Pre-Mortem Strategy: How to forecast "icky" feelings on day one to normalize struggle and keep the lines of communication open.

Gendered Judgments: Addressing harmful social hierarchies, such as the "angry mum" feedback trap, and how to keep feedback factual rather than personal.

Pastoral Conversations: Why understanding the context of a student's life is often more powerful than any clinical performance checklist.

Timestamps

[00:00:00] Intro: The Bold Statement—"Judgment is an Emotion".

[00:01:46] The Elephant in the Room: Why we ignore emotions in debrief.

[00:03:00] The Dishonesty of "Feedback Without Judgment".

[00:05:00] Adrenaline and Cortisol: Why you can’t think straight when the pager goes off.

[00:07:00] The Pre-Mortem: Forecasting the "year of disaster" for students.

[00:09:00] Why we value some feedback more than others: Impressing the "right" people.

[00:12:00] Scenario 1: The "Long, Audible Sigh" and naming non-verbal cues.

[00:15:00] Scenario 2: Dismantling gendered judgments and the "Angry Mum" comment.

[00:18:00] Scenario 3: Legitimizing pastoral conversations over checklists.

[00:21:00] The "Desk Fairy" Analogy: The power of intentional positive feedback.

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Transcript

SPEAKER_00 0:27

Judgment is an emotion. Every time you articulate a clinical judgment to a colleague, you're delivering an emotional message, whether you like it or not. When we claim to be giving feedback without judgment, we're actually being dishonest and hiding things that make the situation worse. If you aren't acknowledging the presence of that emotion, you aren't being professional, you're just being blind. You're listening to Better Every Shift. I'm Naomi, and alongside Tubi we help you move from heavy information downloads to real facilitated impact at the bedside. We're tackling the tyranny of the ignored emotion in feedback. We're unpacking findings from a recent paper, Feedback with Feelings, the Human Complexity of Expressing Judgments About Performance by Margaret Beerman et al. Supervisors and the trainees are constantly creating stories in their heads about each other. And these stories prevent us from starting at a baseline of trust in our next engagement. If you can't articulate that you're pissed off about a broken piece of equipment or an avoidable poor outcome, you can't have a useful conversation about how to fix it. By the end of this episode, you'll learn how to use a pre-mortem to forecast icky feelings and ensure your feedback is a gift, not a grenade.

SPEAKER_01 2:00

The methodology in this that I really liked was observation, testimony, and interview. So there it's really rich, and I admire how they put it together in an article because there must have been so much good stuff that they had to just choose between their favourite children. The overarching message that I got. They've identified a first step to remedy the desire to manage emotions by putting them away, is actually to acknowledge their presence in clinical learning environments. The emotions are the elephant in the room, literally. Not just the figurative elephant in the room, they're the thing that people don't want to talk about because they don't know how to, and they're scared about where it might go.

SPEAKER_00 2:44

They're ignored by so many people in debrief. And if you ignore them, you're making your debrief harder. Whereas if you acknowledge it and you go, okay, they're here, let's talk. Let's deal with it, you are much clearer about what you're talking about. And like we've said before, once you've named it, it's much easier to manage.

SPEAKER_01 3:08

It really clarified that for me, my mission is to upskill people to have those pragmatic, candid, transparent conversations about emotions and their presence and their influence. Yeah. I wholeheartedly agree with you. I think people want to ignore them. Yeah. But then they miss having the conversation they actually really need to have. Yeah, absolutely. They identified that a lot of the literature actually says emotion in feedback is an internal psychological state which can be managed. It's both misleading because it puts it straight on the individual. What you're feeling is your problem that you need to manage. And that's why I'm not talking about it.

SPEAKER_00 4:03

Yeah. It's like so many other things, it's about fearing not being in control, whether that's of a conversation, whether that's of a situation, controlling things really tightly, and we actually then end up with less control because we've completely missed what we should have been looking at.

SPEAKER_01 4:22

You're exactly right. People come out of a feedback conversation completely mystified as to how it ended up where it did, but are unwilling to look at, identify, or acknowledge the presence of emotion in that conversation and what they were avoiding and what assumptions they were coming in with, as well as the other person. That was another thing that I enjoyed about this article was that they said judgment is an emotion itself. Yeah. And so part of feedback is that you are having a judgment and you're you're articulating that judgment to someone else.

unknown 5:03

Okay.

SPEAKER_01 5:03

But in that moment and in that judgment, you're making all kinds of assumptions, which again to me is that argument for more curiosity.

SPEAKER_00 5:13

Completely. Jenny Rudolph's paper, Debriefing with Good Judgment, is about recognizing that we will judge. We will have emotions. Don't get rid of them. But you do need to be aware of them and you need to be aware of the impact that they have, because they have an impact, regardless of whether you want them to or not. So pretending they're not there is not useful because, in fact, that probably makes it worse. And when we say that we're debriefing or we're giving feedback without judgment, we're actually being dishonest and we're hiding things that make it worse. Whereas if I'm pissed off about something because you broke my piece of equipment, or you've now created a whole lot of paperwork that I didn't want to have to do, or we've caused a really poor outcome for a patient, I should be upset. Yes. And I should have emotions about that. And I it will come out in my feedback if I articulate that and can say I'm really upset, but my goal is to get here, then we can have a really useful conversation. But if I pretend there's no problem, there's no problem here. Yeah. We can't actually have a useful conversation because actually there is, and I feel a whole lot of things. It's important that we acknowledge it. And it is really interesting that that hasn't come out more outside of simulation and that the feedback debriefing is not more widely incorporated into how we teach leaders in health to teach us.

SPEAKER_01 6:47

There's a statement everyone intuitively knows feelings are significant, but you're exactly right. They aren't otherwise welcome in healthcare other than in simulation debrief. It's a big problem. But I think when you and I talked about that experience that you had a week apart in ICU with the two emergency kind of situations, they were both driven by emotion.

SPEAKER_00 7:13

Yeah.

SPEAKER_01 7:14

But they turned out quite differently.

SPEAKER_00 7:17

Yeah, emotion has a really big impact. It changes our ability to communicate, it changes our ability to hear properly. If our emotions are running high, we actually just can't think straight. We talked with Nathan about the pager going off. I cannot tell you what my name is when that pager goes off. I know how to pick up the bag and I know how to walk to where I'm going to, and I know how to remember my A is for airway, my B is for breathing, and just keep walking. That's what I know how to do. There is too much adrenaline and too much cortisol that I can't tell you what my name is, and I certainly can't tell you what my lunch order is. And I can't have a nice conversation with you. I won't have a mean conversation with you, but I can't process well.

SPEAKER_01 7:59

Yeah. So one of the things I talked about was that emotion doesn't happen in isolation. In this paper, it's about trainees in surgery and ICU, not just the trainee that's experiencing the emotion. The supervisor is experiencing that as well. And it's actually going out from both of them. They're both creating a story about the experience of the debrief and about each other. Any further engagement, they don't start from baseline. How do you talk to people about that if you've started a story about someone in your head?

SPEAKER_00 8:40

Yeah, part of my strategy around that is to clarify with people what my goal is, because often that becomes really unclear. A really simple strategy when I've got really novice clinicians, new graduates that are starting, that are getting assessed, or people that are a bit further along, but they're in a study mode and they're trying to go up a level, are really anxious. And they're anxious about whether I approve, whether I think they're doing a good job, they're anxious about whether they're doing a good job. And maybe being able to step back a bit and go, here's the goal, here's where you are, these are the things that we're gonna get you to there, is a really useful piece. And to articulate the emotions that I expect they're feeling, and articulate this is gonna be really straight. If I've got people doing postgrad study that I'm facilitating, one of the first things I do in the first day is to highlight this year we'll have things that mess you up. If there's gonna be a year of disaster, this will be the year, and it usually is, and there's usually something really icky for several people in the group. Articulating that and putting that into perspective about what do we do when that comes up. So we've got a plan. It was highlighted on day one. Oh, yeah, she said this would happen. Now we can go back and have a conversation. There's not a surprise. They know that I'm open. That's a conversation that we need to have.

SPEAKER_01 10:06

And it's in that sort of almost pre-mortem space, isn't it? That you're forecasting these things may happen. How are you going to let me know that this is how you're feeling so that I manage your workload better or your expectations better, or we can just normalize actually what you're feeling. I thought was really interesting also in this paper is that emotions are heightened depending on who gives the feedback.

SPEAKER_00 10:35

Yeah. Do you want to describe that for everyone as to who causes us the more angst?

SPEAKER_01 10:42

I think we all have people who we think have earned the right to give us feedback. There's also people whose opinion we value more than others. It's also, am I trying to impress you? And do I feel like I've let myself down because you've had to provide me with feedback? Stories in our head that we tell ourselves about then the value of the feedback. And we receive the value of the feedback often from the person we're trying to impress because we believe number one, they have the right to provide the feedback, but number two, we're more likely to take action on it because they've told us to do it. But what happens for us is we often go into that guilt, shame, I'm not enough kind of feelings, and we will stay there longer because we care about the opinion of the person who's given it to us. Now that's not their intention. No, their intention is probably I didn't expect you to know this, but actually it's you didn't know this, and here's what I need you to do next time.

SPEAKER_00 11:47

Yep.

SPEAKER_01 11:48

The other one that people find really difficult is when they're having their three-month check-in, and that person raises something and provides feedback on something that happened two, three, four weeks ago, and they were not aware that it was a problem then, and they're completely feel completely blindsided now. There's a whole load of stuff that happens when we hold on to feedback. And I know you're a huge advocate for as close to the event.

SPEAKER_00 12:16

But recognize that's really difficult. If you're in an educator role and you weren't the one that saw it, getting that feedback in a timely way so that you can include that in their reports is really difficult to do. And you need to be very proactive in following up for that feedback every week. Because if you're only doing it the week that the assessment's due, you will find, no matter how good you are, unless you are very proactive, people won't come to you. But when you prompt them, what feedback have you got? Then they'll give you stuff. Oh, four weeks ago this happened. You go, great, what am I gonna do with that? How do I put this in? What have we done about it? If we haven't done anything about it, if we haven't said it, it's a really difficult place to be. If those things are important, they're still important four weeks later. You're in a much worse space. It's much easier if you can do it in a timely way.

SPEAKER_01 13:10

And we're letting that person down because we're not addressing the gaps in their learning, and nobody's gonna know everything. That brings home for me why feedback cannot be the responsibility of the educator or the manager or the supervisors or the team leader, even. Feedback needs to be a gift that we give each other. All the time. All the time. We first need to be aware that we're experiencing an emotion in our body because often it sits in our body before we it comes to our brain and we can actually articulate it. Being okay to go, I'm feeling a bit emotional right now. I'm not entirely sure which one it is, but it's there. I just wanted to let you know. For me, this conversation has an emotional edge to it. Um, there's that self-awareness, but then there's also how are we going to support each other to do this better? And it's not just how we give each other feedback or indeed how we receive it, but if someone's not receiving it well, how are we supporting the person who gave that feedback in the first place?

unknown 16:01

Yeah.

SPEAKER_01 16:02

As a team. And that there are a couple of steps I think that lots and lots of teams miss, which is why you're exactly right. Giving in the moment feedback can be really hard.

SPEAKER_00 16:14

Okay, Tooby, we're going to work through some examples and scenarios about how we would respond in different situations regarding emotions as part of feedback. So, my first scenario for you is you're supervising a new graduate during a complex dressing. They're taking slightly longer than usual to set up the procedure trolley, and without thinking, you let out a long, audible sigh. While you were just tired from a long shift, you notice the new graduate's hands begin to shake slightly and their pace slows even further. How are you going to address the unintended emotional stickiness of your nonverbal cues in real time?

SPEAKER_01 17:04

First of all, I would address my big sigh, particularly after I noticed their hands shaking. I would say you might have noticed I just did a big sigh, but I want to be really clear with you. Me sighing is not about what you're doing. Me sighing is just an expression of my tiredness level. I'm not sleeping particularly well for whatever reason. And I don't want you to think it's actually about me being impatient with you. You're learning how to do this. It's going to take some time. That's really normal because you're new at it. The more you do it, the better you're going to get at it.

SPEAKER_00 17:54

I love that. It's really important, isn't it, that we just acknowledge that none of us are perfect and take that guesswork out for people because people are so often just trying to guess and they go in the wrong directions. So yeah, I think that's a really useful response. Okay, another tricky one. During a debrief, the senior consultant tells a female registrar that her communication during a trauma call comes across as aggressive and like an angry mum. The registrar shrugs it off in the moment with a joke, but later you find her in the break room looking visibly unsettled and questioning her future in the specialty. How do we dismantle gendered judgments about feelings that reinforce harmful social hierarchies rather than improving performance?

SPEAKER_01 18:48

This is a really tricky challenge because sometimes we say things without thinking. We say things from our own perspective, from our own history, and we don't stop and think about how will my comment be received by this person. The comment coming across as aggressive and like an angry mum makes it very personal. But actually, while we are giving feedback to an individual, how we give that feedback doesn't have to hurt to be useful. And so another way to say it could be you came across as a bit blunt. And for some people that might seem like you're a little bit angry. Can I just check in with you after that trauma call? Another thing I'd probably add to that is when we're feeling stressed, we may not hear ourselves the way we come out. And the way our words come out may not be as we intend them. They might be short, they might be blunt, they might sound harsh. So we have an opportunity. One is to have a really strong intention of remain remaining calm and at ease, or at least sounding like we are. The other part is to actually say to seek feedback. Hey, during that trauma call, I was feeling quite stressed in some of those moments because the person was quite unstable. And I was wondering if I came across as a little bit aggressive. I didn't mean to. I was probably blunt because the cognitive load at that time, I was really trying to think through what are our options here, what might be happening. But I just want to check in with you. How did you receive me? I think when we're providing feedback to people, so that's how we can seek our own feedback, but when we're providing feedback to people, it's really important to take out the personal and keep it factual so that it's useful without being hurtful.

SPEAKER_00 21:19

Yeah, the other element which is described in the paper that we're referring to is that there's often a gendered inequality about what we expect from each other. So this comment probably wouldn't have been made if this registrar was male, which is challenging. So if we expect men to raise their voices and it's often fed back quite differently. Whereas women in this space we expect them to cry, we don't expect the blokes to cry. And we need to be really careful when we're giving feedback that we're not perpetuating that even further to see how they pointed that out in this paper. All right, my turn for a question, TB, far away.

SPEAKER_01 22:03

You notice a normally high-achieving postgraduate student nurse looking exhausted and a bit checked out. Instead of sticking to a clinical performance checklist, you just ask a simple open-ended question instead. What's affecting you right now? This leads to emotional disclosure about their personal life and the hopelessness they feel trying to balance it with training. How do we move beyond managing emotions as background noise and start legitimizing these pastoral conversations as a core part of the feedback loop?

SPEAKER_00 22:47

Good on me for asking an open-ended question, and I'm glad that we got to some of the meaty stuff. It's too easy often that we follow the checklist or that we go to the real clinical content about did they get it right. Whereas asking the deeper questions about what's affecting you, where are you at, what are you struggling with, what's working really well, enables you to go a little bit deeper and get people to where they need to be. You still need to go through some of the checklist type items, you still need to articulate for people where they should be, but understanding the context that's sitting in for the individual is so much more powerful for them. And often in these situations, there often is a personal element that has a really big impact at work, and particularly in somebody that's studying, and being able to articulate for them the other element of studying and learning new things is that now you start to question all the things that you thought you knew. So everything gets harder. The flow of work that we had previously. People that come into critical care areas often find that they've started to get quite a flow in their work by three or four months. Then, as they really start to learn in a new way, their work actually gets harder because now they're questioning things more and they're having To rethink and actually model for themselves the process and structure that they need to be working in, so everything's actually harder. And helping them articulate that and understand that process makes it easier for them in the long term. We absolutely need to take time to ask some of those harder questions, even though it's more difficult for us because we don't quite know where it's going, it is so much richer for the individuals and for us as well. I commented actually on a LinkedIn post this week around feedback. There was a mum who described her daughter had come home with a note from the desk fairy that was really pleased at her clean desk that her daughter had. And the daughter was so excited, there was a little lolly attached to the little note. It will have taken the teacher a little while to set up. And I imagine from the structure of it that the teacher's probably got a few of these pre-planned, right? And they give these out. But not super hard, not super taxing, certainly not challenging. But just imagine, I mean I'm not suggesting we all be fairies. Yeah. But if we were intentional about giving a few extra pieces of positive feedback every day, then people get used to us commenting on their work. They recognize that they're seen that we've got their best interests. So that when we've got more difficult feedback to give, we actually have somewhere to start from. And it's not all negative. Actually, I do feedback all the time. Today I'm gonna have some really hard feedback that's gonna take a little bit longer to process. And tomorrow there will be another piece of you did that really well.

SPEAKER_01 25:59

I don't think we say thank you enough, and we don't provide the detail of why we're grateful. And I hear so often, I don't get feedback unless there's something wrong. And there's two things wrong with that. One, you don't know when you're getting it right, so you don't know how to repeat that. The second, you're also always on alert, waiting for the feedback about what you've done wrong because you don't know when it's coming because it's the only time you ever get it. One of the trainees, after some feedback with a supervisor, and they said, I'm left alone wondering, they were clearly unimpressed with that, but why? What could I have done differently? What weren't they happy with? Um, and they said sometimes people forget that their body language tells a thousand words. So if we go back to that emotion, you might think you're being really calm and even, but your body is betraying you. So going right back to the start of this conversation, when you don't recognize or acknowledge emotions are here present with us, also, and having an influence, and we need to remember that, people will still pick it up, and you're undermining their trust in you by not articulating it.

SPEAKER_00 27:18

They will make another point about feedback. What's anticipated that the participant will receive is often not the case. But there's lots of emotions when people feel that they're getting blindsided by feedback and that it is late to your point earlier. The emotion that comes with that is massive when it is late and it feels like it's undermining them.

SPEAKER_01 27:44

What they identified was that supervisors are making assessments on what people should feel as a result of receiving the feedback or as a result of the interaction. But they're not checking in, they're not curious about it. They're also not saying, in this feedback conversation, I really want you to feel reassured and validated. You might actually feel a bit disheartened and a little bit embarrassed. It's it's all normal. We all have expectations, we should know things, but it's not possible to know everything. Prefacing it like that, it forecasts your intent. I don't want you to walk away and feel confused, you're not one of us kind of feeling. But I acknowledge me giving this feedback may also spark some other emotions in you, but I'm not assuming what you should feel.

SPEAKER_00 28:41

I'm really keen that we offer three teams the opportunity to do self-directed learning with us. If there's three managers, educators that get hold of us and give us details for their team and we set them up with training and we give them coaching for a month around feedback and give us feedback about how useful that was for the team. So if you'd like to work on feedback with your team, make contact with us. Your team needs to be between 12 people and 60 people. If you contact us via our website www.bettereveryshift.com.au, we will make touch with you and set up that your team has got access to e-learning, coaching for a month, and we then want some feedback for you from you about how well that works for your team. We're really excited to offer this. Thank you for that discussion. So, our challenge for you this week: in one feedback or teaching conversation, name the emotional edge instead of pretending it isn't there. Good luck. Thanks for listening. You can check out the show notes and find lots of further resources at bettereveryshift.com.au or via the link below. If you enjoyed today's episode or would love further information, we would love you to subscribe. And we look forward to seeing you better every shift.