GME guidance

How to make mistakes and recover from them as a resident

Learning how to make mistakes with grace and take your failures in perspective might be the most important skills you can develop as a resident.

As a medical student, you learn to develop an early tolerance for being wrong. A lot. It’s a difficult and uncomfortable skill, but you quickly build a healthy respect for the missed questions because those are the ones you learn the most from.

Once you graduate from medical school, however, the dynamic changes in one crucial way: Your name is signed to the orders. For the first time, you have responsibility for patients. Your actions now have weight, your mistakes have consequences.

While you have senior residents looking out for you as an intern, and attendings doing that when you’re a senior resident, having oversight can actually make the experience of getting something wrong even more challenging because of the social pressures involved.

All of this establishes the abilities to make mistakes with grace and take your failures into perspective as possibly the most important skills you can develop as a resident. Below is my best advice on gracefully making mistakes and recovering from them in residency.

1. To err is human.

Almost every other resident I’ve spoken to has at one time or another struggled with this bizarre, senseless inclination that we are somehow expected to be perfect out of the gate. I don’t know where this comes from. Maybe it’s a manifestation of imposter syndrome that we put on with our long white coats?

I remember beating myself up as a medical student for missing a question from an attending on an audition rotation for a disease I had only ever read about. I barely noticed that the interns and residents on the team hadn’t been able to answer the question either.

Maybe this drive to be perfect has been baked into us since the start? I was recently on a cardiology rotation and dreaded going in to prereview the caths for the day with the interventional cardiologist. Partly this was because I respected them immensely, partly because their knowledge and experience made me absolutely no match for them. No matter how I prepared, I just seemed to get everything wrong.

It wasn’t until near the end of the rotation that this changed. Another cardiologist came in and was reminiscing about an attending they once both had in fellowship who was infamous for cornering the brand-new fellows in their first months and grilling them on coronary anatomy. The interventionist admitted, “Yeah, I didn’t get many right at first.” Then he looked at me and said “See? You’re ahead of the curve.”

Despite the expectations that you shoulder on yourself, nobody else is legitimately holding you to standards above your level of training. And even as an attending, perfection might be the ideal, but you’d be hard-pressed to find anyone who would agree that it is actually possible. Ultimately, you are a human. Know that you will make mistakes. Your supervisors are expecting you to, and they are comfortable with it.

Loosening the burden of perfection is the first step toward viewing mistakes as less negative and more as a part of the experience of learning and growing as a physician.

2. Mistakes are opportunities for learning.

Again, if you were already perfect, you would not need anybody to train you. Once you start to see mistakes as opportunities, then you can realize how important they are as opportunities to learn.

Evolutionarily, the human brain is set up to encode threats as memory in a significantly stronger way than positive or nonthreatening memories. Understandably, this was to help our ancestors remember that spot by the fruit bushes where the tigers liked to hide. It’s the same reason that you can barely remember the specifics of the fun surprise party your co-residents threw you last week, but that one time you came to high school with your shirt on backwards still keeps you up at night.

The mistakes we make as doctors are encoded like that — both because of the risk they pose to our reputations and to patient safety. Even something as simple as missing a question in a Q-Bank might jar you. It’s easier said than done, but try not to think of the bottle of spilled milk in front of you. Instead appreciate all the full bottles you’ve saved that are still in the future.

Additionally, cherish the opportunity to miss things and learn from them while you’re in training; you have teachers and support, and the system is more forgiving. You will still make mistakes when you’re truly running the show, but you’ll have a bit less support and more accountability.

3. Remember, it’s not you.

Let’s talk about the really uncomfortable stuff: What happens when you make a mistake or miss a diagnosis that nearly or actually results in patient harm? These are the moments where the tiger in the bush gets a piece of you: ­humbling experiences that unfortunately, are impossible to completely avoid in residency.

When something like this happens, it’s natural to feel shaken to your very core. You may not simply feel regret about the situation, but instead may find yourself questioning your entire mandate to become a physician.

The worst thing a mistake (especially a serious one) can do is incorporate into your self-identity. This is when it’s most important to remember that it’s not “you.”

You are not a bad doctor. You are human, you are doing your best, nobody expects perfection and nobody is immune to mistakes. Your mentors, your heroes, those sub-sub-sub-specialists who consistently awe you with their brilliance — all of them have been in a position where you are and have faltered before. All of them have missed something, or misinterpreted a finding, or recognized an obstacle too late. They have survived, reflected and come out as better physicians because of the experience.

So when you make a mistake that really rattles you, don’t dive right back into the fray. Take some time to think about what happened, remind yourself that it’s not you, and resolve to learn from the experience so you can hit the target next time.

Know that you are appreciated and supported, and ask for help if you need it. And finally, don’t be afraid to talk about your mistakes with others. You may help others avoid making the same error, and through teaching, you can persevere and carry on.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

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One comment

  1. Sheila

    What happens when a resident refuses to admit to possibly making a mistake and the doctor above the res. won’t either. What if this mistake could lead to a patient who has severe depression feeling absolutely hopeless. This could end very badly.

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