Tag Archives: burnout

Toxicity of “be the best” culture

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“When you show up to those evaluation meetings, I want you to show up like a star athlete, wanting to improve in every way possible. We want you to become the best doctor there ever was.”

This was the response of an education specialist when asked how can residents cope with being constantly scrutinized and given “areas in need of improvement” at every assessment that occurs at least once a week.

Growth based mindset is a valuable asset in anyone, especially in young doctors who have so much to learn. HOWEVER, there comes a point where a resident becomes good enough to practice safely and competently according to practice guidelines. Beyond that point, it can be extremely demoralizing for residents to receive criticism on something that is not helpful for improving the quality of patient care in a measurable way. Specifically, receiving feedback for the sake of feedback, in a patient interaction where care was safely and competently delivered, can be exhausting for the learner. It can also impede their sense of mastery, contributing to burnout, anxiety, imposter syndrome, and demoralization. At the time of COVID-19 where residents are being redeployed into areas outside of their specialty in a particularly stressful environment does not make things any easier.

We see this outside of medicine as well. Social media bombards us with messages of “be the best you can be”, “achieve all that you can”, etc etc… While these messages can be motivating to a certain extent, it can also feel like a lot of pressure in this world that is already so competitive and stressful.

You ARE enough.

Did you get up today and go to work, even if you didn’t want to? Did you do what you could to finish the work that was needed within a reasonable time frame within the minimum required standards? Were you reasonably kind to others and didn’t hurt anyone, including yourself?

GREAT! In some days, even doing these things can be extremely difficult, so great job!

As a society, it is time we re-evaluate this “growth based mindset”. Growth is great, but so is happiness, satisfaction, and gratitude for who we are today. Striking the right balance between these essential aspects of life should be the focus, not endless “growth and expansion” at the expense of one’s wellbeing.

Again, you ARE enough.

Angels in our lives

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I was having my biannual review of competency today when my evaluator told me, “I am sure you are tired of people cheerleading you all the time but I just want to cheerlead you again, to keep up with your good work”.

I wish I could tell him how much his words meant to me. The thing is, at least in medicine where I work at, I do not get much cheerleading, if at all, for my successes. If anything, disclosing my research work or records of my other accomplishments have resulted in hostile behavior from supervisors and bias them to think that I am not invested in learning from them or that I think less of them because of my accomplishments. This is why I don’t offer up this information unless asked directly – even then, it is often met with, “Oh really? I guess you must be really bored here then”, or “Oh really? We need to make sure this becomes a good *learning opportunity* for you”.

This is a biproduct of an education system that thinks pointing out an individual’s flaws, instead of celebrating their accomplishments, is going to get them to learn more effectively. To this opinion, I would like to ask what evidence they are basing this on. Education theory 101 taught in teaching school states that for students who are internally motivated, strength-based teaching approaches work much better than criticism-based approaches. This is where the sandwich model of delivering feedback was developed, where teachers are coached to provide one constructive feedback in the middle of two positive feedbacks. Focusing only or mostly on short comings does NOT motivate a leaner to do better – it gets them to be comfortable with failing. One can call that developing resilience. Well, most residents would prefer to call it “learned helplessness”, which is one of the core dimensions of depression. If no matter what we do, all we can expect is criticism, then why should we try at all?

Of course, we are learners and there is MUCH we need to learn, and evaluations of those necessary skills make a lot of sense. However, evaluation for the sake of evaluation, not producing competent health care providers, discourages cheerleading and breeds and selects for educators who “get off” of criticizing learners to boost their own ego. The system that I am in even penalizes educators who give favorable evaluations to learners – someone please tell me how this makes sense. If we can’t count on our educators be our cheerleaders, in this harsh society where medicine and doctors are more demonized than ever, who can we depend on?

When I teach medical students, my first priority is to make sure that they are treating patients in a safe way and if they can’t, that they feel comfortable enough to come tell me. My second job after that is to make sure their learning goals are met in the context of what field they want to specialize in. If their field of interest does not relate to my field at all, then I make it a priority to get them home in time so they have the time to devote to self care and studying for their area of interest. Evaluations that I provide are always strength based, because more often than not, medical students are more than WELL AWARE of their short comings. I learned to do this from the many wonderful teachers I met in my life who have done this for me. My very own cheerleaders that taught me the joy of cheerleading for others and how rewarding that experience can be.

Cheerleading is not something to be taken for granted – many people, even in education, are not capable of this or know what it feels like. While this post was largely a rant of my frustrations towards the education system that I am in, I also wanted to take a moment to express my gratitude for the cheerleaders in my life – my husband, mentors, and of course my goddesses and spirit guides. May their lives be three fold as blessed as the light they have shone in my life.