Feedback, neurodivergence and rejection sensitivity dysphoria in medical education

Rejection Sensitivity Dysphoria (RSD) is an intense, deep rooted feeling of embarrassment, anxiety and failure that can be all-consuming and deeply impactful. RSD is common in neurodivergent learners, particularly those with autism and ADHD. It is essential that medical educators' feedback strategies recognize and support those with RSD, so that distress may be reduced and these learners can rightfully flourish in medical training. Moreover, by adopting a relational and inclusive approach to feedback, other learners will also benefit, particularly those who are anxious, highly self-critical or perfectionist. This paper supports educators to understand and recognize RSD before discussing approaches to adapting feedback. Addressing a mismatch between learner needs and the feedback process or environment is key. Utilizing alternative feedback models, prioritizing rapport, providing written feedback and supporting learners to manage their emotional dysregulation are practical strategies.