Canadian Medical Association

Perfectionism in medicine is about setting rigid or unnecessarily high standards for flawless work or performance for yourself or others. 

Medical students need balanced ways of pursuing high standards, which can motivate and energize, while avoiding unrealistic performance expectations that can cause stress.

Causes and effects of perfectionism in medicine

Doctors are expected to know all the answers — and because medical mistakes can have fatal consequences, many students believe they have to be perfect all the time. As consistent perfection is impossible to achieve, this can have a negative impact on their mental wellness. 

Perfectionists can be so focused on avoiding failure that they neglect self-care. They’re often unhappy even when they achieve success and tend to get stuck on the details, which can make them slow and inefficient. The feeling that their best is never good enough can lead to anxiety, depression and suicidal ideation, according to studies in BMC Medical Education and the Journal of Personality.

Strategies to share with students to overcome perfectionism and promote mental wellness

To help overcome perfectionism and promote wellness, Dr. Melissa Whelby recommends the following strategies:

  • Maintain perspective: not every decision or action has dire consequences. Ask yourself, “What’s the potential impact of this decision or action? Is my anxiety warranted?”
  • Seek middle ground: don’t get trapped in black-and-white thinking. A lack of perfection doesn't equal failure and not being the best doesn't mean you're the worst. 
  • Have realistic expectations: practice self-compassion and avoid harsh self-judgement. Unrealistic standards lead to self-neglect. It's difficult enough to keep up with the daily demands of medical school and maintain a balanced life. 

Another reason to avoid perfectionism: mistakes help us learn and grow. Growth can come when we admit something went wrong, analyze why and decide how to prevent a recurrence. Mistakes can reveal our strengths and limitations, and make us more tolerant of colleagues, classmates and patients. 

Medical student Sehr Kahn stresses that learners should ask for help by sharing and talking about their failures with trusted friends or mentors instead of trying to face them alone.

Lastly, it’s important to avoid false pride. This means avoiding ego, arrogance, the need to prove yourself and the inability to make mistakes — and allowing yourself to be vulnerable. Being authentic and genuine is the key to feeling more natural and relaxed.

How to build a psychologically safe environment

A psychologically safe learning environment can foster open reporting, active questioning and frequent sharing of insights and concerns.

Julie Morath, former chief operating officer of Children’s Hospital and Clinics of Minnesota, led a highly successful program to reduce medical errors. Here are her top five recommendations:

  • Clarify the kinds of failures that can be expected. In a complex operation such as a hospital, many large failures are the result of several small events. Spread knowledge and understanding of errors.
  • Those who come forward with bad news, questions, concerns or mistakes should be rewarded rather than punished. Blameless reporting encourages students to reveal medical errors and near-misses anonymously. 
  • Ask for observations and ideas and give students opportunities to detect and analyze failures. 
  • Be a positive role model by being open about what you don’t know, sharing mistakes that you’ve made and admitting areas where you need help. This encourages others to do the same. Make it clear that you will need help from everyone to reduce errors.
  • People feel psychologically safer when they know which acts are blameworthy. If someone is punished, tell those affected why consequences were warranted (e.g., reckless conduct, conscious violation of standards, failing to ask for help when over one’s head). If a learner makes the same mistake multiple times patients may be at risk, so ensure extra vigilance.

Other tips to become a better educator and mentor

In addition to creating a psychologically safe learning environment, you’ll also want to:

  • Empower and support medical learners to identify, analyze and remove hazards that threaten patient safety
  • Refrain from using perfection as a compliment or badge of honour 
  • Teach students to pursue excellence and diligence rather than perfection
  • Disseminate clear, accessible procedures to guide behaviour when errors do occur
  • Teach in emotionally charged situations to learn from errors and near misses, and to balance between individual and system responsibility
  • Remember your own failures and shortcomings to develop tolerance
  • Never shame a student for failing or making mistakes.

Watch for signs of impostor syndrome

The drive for perfection is closely related to impostor syndrome: a psychological pattern of fear and self-doubt that interferes with people’s belief in their own accomplishments. 

Imposter syndrome can burden students with the persistent fear of being exposed as a fraud, despite high grades and kudos from educators. 

Robyn Correll offers some insight into how to spot and mitigate impostor syndrome.

Students suffering from impostor syndrome may:

  • Pass up opportunities because they don’t think they’ll succeed
  • Downplay achievements
  • Overprepare and overachieve 
  • Self-sabotage 
  • Feel anxious, depressed and burnt out

To overcome impostor syndrome, teach students to:

  • Seek constructive criticism 
  • Focus on their strengths and accomplishments 
  • Learn to welcome praise 
  • Reflect on their own history and circumstances 
  • Invest in positive relationships 
  • Rethink how they define failure 
  • Not be afraid to ask for formal or informal help

Perfectionism in medicine and impostor syndrome are just two of the problems that medical learners encounter. Use this article to help medical learners establish a wellness mindset.
 

Topics

Psychologically safe learning Establishing a wellness mindset

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