Giving feedback.

BACKGROUND: Giving feedback is a core element of medical education, one that is gaining attention but with a thin evidence base to guide medical educators. This review provides a definition of feedback and its purpose, selectively reviews the literature regarding educators' and learners' attitudes toward feedback, and provides an algorithm for giving feedback. DISCUSSION: The authors discuss the parallels between giving feedback and breaking bad news, emphasizing the importance of titrating the amount of information given, attending to affect, and making a plan for next steps. Special considerations for giving feedback in palliative care are highlighted, including the effect of heightened emotion in the clinical encounter and the difficulties of giving feedback about communication skills.