Breaking The Silence: A Content Analysis of Medical Students’ Perceptions of Failure in Medicine

Abstract Background Failure in medicine may cause severe harm to patients, especially in surgery where failure has immediate consequences. Despite often being an emotionally stressful experience for surgical residents, failure is a powerful teacher as well. Before entering residency where failure is inevitable, medical students should ideally learn how to talk about and cope with failure. Aims Educational interventions to support learners to regulate failure and its consequences are rare. Therefore, a four-day workshop entitled “How Physicians deal with Failure in Medicine” was offered to medical students at an academic institution to open the conversation about failure in medicine. Methods The curriculum provided insights into the ubiquity of failure in surgery and beyond. 30 participants wrote reflective essays as a pre- and post-intervention task. Tutors, namely two surgeons and a life coach, facilitated presentations, group discussions, and journal clubs about failure, and discussed potential coping strategies. Results The content analysis of 60 reflective essays revealed various self-experienced and observed failures in the clinical context. Experiencing and witnessing failure was emotionally draining and often in conflict with expectations of being a physician. Fear of failure was omnipresent, while students realized that failure in medicine is human and inevitable. Perceived clinical supervision often protected medical students from failure and its potential consequences. However, open communication about failure rarely occurred. Overall, medical students emphasized the importance of open conversations about failure to learn from it. Conclusions Medical students wish to discuss failure before entering residency. Without open discourse about failure, medical students, and later residents feel left alone with their experiences, triggering fear. Clinical supervisors should support learners entering clinical training by being more transparent about their own failures and sharing their coping strategies which will ultimately help them to make sense about failure experiences in order to learn from and cope with it.