Back in 2007, when we first started thinking about creating a new Ed School from scratch, Kenny and I met with 3 directors of Harvard Medical School affiliated residency program. We were trying to learn about common challenges in training bright 20-somethings: people who, as undergrads (and in medical school), were rock star students.

Each doctor described the same concern. Attending doctors (the veterans) were often reluctant to give enough negative (but needed) face-to-face feedback.

Instead, attendings would

a) make technical corrections to rookies, but in a way that withheld negative judgment, b) instead approach residency directors and say the nasty stuff.

Of course the residency directors would get frustrated. These rookie doctors wouldn't improve if they didn't get the tough feedback.

Why are people so cautious in giving feedback? Dopamine.

With an evaluation, you expect something. You make predictions. So there are 4 scenarios.

1. Expect critique -- get praise. 2. Expect praise -- get it. 3. Expect praise -- get critique. 4. Expect critique -- get it.

What happens in your brain? Courtesy of a great blog called Neurotopia, we learn about a defining 1997 experiment:

First, they took a bunch of monkeys (it has also been done in rats) and implanted electrodes to record neurons in the Ventral Tegmental Area of the brain, an area that contains lots of dopamine neurons. With these electrodes, they could watch the neurons fire. In this case, they gave the monkeys an unexpected reward, fruit juice.

See that spike above the "R"? That spike is a spike in dopamine neuron activity when the monkeys on unexpected fruit juice. The neurological equivalent of "w00t!".

They then trained the rats on a conditioned stimulus paradigm. Basically, they paired a tone or light with a dose of fruit juice for the monkey. This meant that, when the monkey was done learning, it knew that when it got a light, fruit juice was forthcoming. And the neurons in the monkeys brains SHOWED the result of the learning. It looked like this:

This is a condition where the monkey was given the tone (or light), and got the reward it expected. You can see that here, the spike in dopamine neuron activity has shifted, this time corresponding to the tone (woohoo! juice is on the way!) rather than to the reward itself.

But then, what happens when the conditioned stimulus of the tone or light is given, and no juice arrives?


The spike is there, the monkey is waiting for juice. No juice arrives. And instead of normal firing, when no reward appears, there's a DECREASE in dopamine neuron firing (the circled portion).

That monkey's been Rickrolled.

Makes sense to me. That's my own reaction when I get unexpected critique.

It also describes my 2 year old. Literally. When he expects juice, you basically have about 5 seconds to get it poured, cut it with water, in his sippy cup with lid securely fastened, and in his hand.

Otherwise dopamine hell.

As a teacher training program, how do you deal with dopamine?

1. Create environment where trainees give permission in advance to sometimes get the Oooh Buurn reaction. Use this permission to train coaches that they must shoot straight and not back down.

2. Use numerical ratings of each teaching session. We use 1 to 10 scale. Why?

a. Written/verbal evaluations alone require interpretation. If I say the class you taught had 3 strengths and 3 weaknesses and I describe each of those -- well that class could have been great overall or terrible overall.

But if I tell you it was a 2 out of 10 or a 7 out of 10, you know where you stand.

b. The only way you're going to be cool with getting, say, a 3 out of 10 is if last time you got 2 out of 10. Yes, the class overall is still weak. Yet you got a little dopamine boost because the 2 went to a 3.

3. Cross-coach ratings alignment. Needs to be like skating. If one judge gives a 5.8, almost all the other judges will be within .3 of that rating. Except the East German judge.

If a trainee gets 3's on Saturday and 6's on Friday, she'll of course be flummoxed.

4. Frequent feedback. For two reasons:

a. Frequency helps align trainee and coach. This lowers the hi-lo rating combo that cuts dopamine.

b. Frequency probably diminishes the size of dopamine effect.