COMMENTARY

Med Students Must Learn to Deal With Criticism and Failures

Arthur L. Caplan, PhD

Disclosures

November 25, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU School of Medicine.

How tough can you be on medical students?

Some of you watching this are thinking, Well, when I was in medical school, people were very tough on me. They were highly critical if I did something wrong. I got yelled at. People weren't afraid to embarrass me in front of others and say that I hadn't prepared well, I didn't know my stuff, or I'd made a mistake. Mentors could be tough.

More recently, we've seen literature start to emerge, asking whether we are being too tough or too difficult with medical students, residents, or fellows. The literature has led to the suggestion that maybe we have to walk on eggshells around younger people who are learning their way and becoming doctors.

I don't think that's right. Neither does a recent editorial in JAMA Pediatrics, which said that the right way to deal with the tough part of medicine—when you make an error, you slip up, you don't know what to say when someone's dying, or there's a tough choice to be made and you're confused—is not to walk away from the difficult situation. To put it another way, don't coddle people.

It's not acceptable to bully, physically threaten, or act in a way that isn't respectful of people. Medicine is tough and becoming a doctor is no easy task. One of the ways to cope with the challenges and to avoid burnout is by learning skills that allow you to deal with difficult situations in the reality of mistakes and errors.

You don't just need coping skills, mindfulness, or to learn to meditate. You need to know how to respond—what to say and do. It's a hard profession with difficult situations. Frequently, you're going to come out of those situations feeling upset, angry, or ashamed. That's what has to be taught.

The reality is that those feelings are part of being a physician. You have to learn to decide how you're going to approach conversations; have a script in your head about how to broach tough subjects. You have to learn to go on and muster resilience, which is my favorite antidote to burnout in the face of failure, error, or a mistake.

I don't think we should be walking on eggshells. We certainly don't need to go back to the "bad old days," when people were hefting sponges at other people's heads to get them to pay attention or to reprimand them.

In a tough field, we have to move forward by getting people used to the fact that they could be criticized in front of others and they need to be able to offer criticism of others, and it is okay.

It's morally justified to deal with tough situations in ways that let people cope. Teaching those resilience skills is the best answer—not avoiding them.

I'm Art Caplan at the NYU School of Medicine. Thanks for watching.

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