Giving feedback is a necessary and expected part of training students and residents, but giving effective feedback can be challenging. Lack of time, concern for upsetting the teacher/student relationship, worry that their own evaluations will be affected, or fear of distressing the student are common reasons that educators may avoid giving feedback to learners. These barriers are intensified when the stakes are high: for example, when a trainee has done something that appears unethical or unprofessional. Preparation and having an effective feedback approach are critical to success. This chapter will provide the tools to give effective feedback even when the stakes are high.