There's an email that's been circulating from a student who graduated last year. She has moved on to a prestigious residency program now, but her confessions as a medical student helped us all. When I first heard her talk, she had no idea where she would be landing. She came to speak with us during a lunch hour on my internal medicine rotation. I remember that she was casual in her delivery: "I failed a clerkship exam; I'm still here." And yet her story of failure stands out because I've heard so few. How is it that our failures are nearly preordained and yet our closest-kept secrets?
Moderators read her email — detailing her failures and ultimate successes — aloud during a yearly panel held for second-year medical students preparing to enter their clinical clerkships. I remember this panel distinctly from when I was in those cushioned, red lecture seats because I remember thinking, There are so many ways to fail.
A brief glimpse into the mind of a medical student preparing to enter clinical rotations: Who do you talk to and when, what do you wear to wherever you go, and when and how do I ask if it's time to go home? Anyone who has been through clinical rotations or worked as a resident will recognize what I mean when I say, "Is there anything else I can help with?" It's become such a ubiquitous, thinly veiled inquiry to head home as to defeat its purpose of subtlety. There are numerous prescripted dialogues and expectations for performance that to misstep is nearly inevitable.
On my second month of clinical rotations, I received the following frustratingly abstract pearl of feedback: "Work on being more situationally aware." It became a tongue-in-cheek joke between my friends and me. When one of us wasn't paying attention, forgot a birthday, or arrived late to dinner, it was always, "You should really work on being more situationally aware." It removed some of the sting when I could use it on others.
After over a year in clinical rotations, I still have no idea what that resident was referring to: Was I standing with my back to a patient, did I spend too long at lunch, or sit in this resident's favorite chair? However, I do know that I've never gotten feedback like that since. This is to say, you may transgress in ways you never thought possible. Try not to hold onto your slip-ups too tightly; after all, residents and attendings must write something in the "areas for improvement" box.
For some students, medical school is their first taste of failure. As the number of medical school applicants increases, consistent academic success is practically a prerequisite. Once in medical school, students are challenged every step of the way, our knowledge accumulated then tested again and again with vertiginous rigor. I can say both that I loved medical school and yet no year was easy. With each year came a new set of challenges as starkly different as the Iowan seasons.
Can you recall a time when you were a kid (perhaps a teenager) and you broke something or made a mess and your first inclination was, above all else, to hide the evidence? Can I be honest when I admit the number of disfigured or discolored items I've blamed on my younger sister over the years? What is a broken vase to a child but cause for scolding. Admitting failure is a learned skill.
In the classical version of the Hippocratic Oath, physicians vow to keep patients from harm. As far as I can tell, the only way to keep this vow is to admit harm when it has been done. As physicians and physicians-in-training, the onus is on us to encourage the admission of mistakes, learn from them, and become better providers for them.
In a study on physician perception and approach to medical error, one participant is quoted, "It's a very visceral thing. You did something with your hands to someone else's body, and it went wrong. And there is nowhere to hide, there is no system to hide behind, there is no medication error, there is no pharmacist, there is no whatever. You were there, you did this to this person, and it went wrong."
Even our board exams have begun to help us practice for the moment our hands, our minds, betray us. While studying for my board exams last year, I came across several questions accessing the ethics of revealing medical errors. The question begins innocuously enough: "A 60-year-old man arrives at the surgery center for a left hernia repair." The surgeon operates on his right side instead.
Wrong-site surgeries are considered sentinel events, mistakes that result in extreme harm to the patient. The question proceeds to ask you, as the surgeon, whether, when talking with the patient and his family, you will (A) attribute the right-sided incision to another hernia, previously undiscovered; (B) accept responsibility for the mistake; or (C) blame the system, or worse, (D) someone else.
When I think about what it means to have "MD" trailing my last name, this is the part of the job description that keeps me up at night. One day several years from now, when I'm no longer a student or resident, every mistake will be mine alone to own and admit.
During the final week of my anesthesiology rotation this winter, I felt like I had nearly mastered IV placements. I liked placing the tourniquet and watching the veins swell with blood, tributaries thwarted on their return to the heart, tapping the veins to provoke histamine release and further dilation, piercing the straightest branch of all, and watching for the flash of blood in the hub before retracting the needle. The last day, I struck the back wall of the vein; there was no flash of blood, just the blood on the operating room floor and between the patient's fingers.
The resident said it happens to everyone. I shrugged, "If I haven't made a mistake, I haven't done it enough." And it was true; I knew more practice would mean more mistakes. I ran an alcohol swab over the patient's hands and between the fingers. I was only sorry she had been stuck twice.
So, when I graduate this spring, I graduate with a shifted appreciation of failure and mistakes. By leveraging my mistakes as opportunities rather than shortcomings, I am reiterating my desire to improve. For students just beginning their medical school journey — this is my message. And the answer is always B.
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Cite this: Liana Meffert. What Benefits Arise From Early Failure - Medscape - Mar 03, 2022.
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