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Shifting and Sharing: Academic Physicians’ Strategies for Navigating Underperformance and Failure

LaDonna, Kori A. PhD; Ginsburg, Shiphra MD, MEd, PhD, FRCPC; Watling, Christopher MD, PhD, FRCPC

doi: 10.1097/ACM.0000000000002292
Research Reports

Purpose Medical practice is uncertain and complex. Consequently, even outstanding performers will inevitably experience moments of underperformance and failure. Coping relies on insight and resilience. However, how physicians develop and use these skills to navigate struggle remains underexplored. A better understanding may reveal strategies to support both struggling learners and stressed practitioners.

Method In 2015, 28 academic physicians were interviewed about their experiences with underperformance or failure. Constructivist grounded theory informed data collection and analysis.

Results Participants’ experiences with struggle ranged from patient errors and academic failures to frequent, smaller moments of interpersonal conflict and work–life imbalance. To buffer impact, participants sometimes shifted their focus to an aspect of their identity where they felt successful. Additionally, although participants perceived that insight develops by acknowledging and reflecting on error, they sometimes deflected blame for performance gaps. More often, participants seemed to accept personal responsibility while simultaneously sharing accountability for underperformance or failure with external forces. Paradoxically, participants perceived learners who used these strategies as lacking in insight.

Conclusions Participants demonstrated the protective and functional value of distributing responsibility for underperformance and failure. Shifting and sharing may be an element of reflection and resilience; recognizing external factors may provide a way to gain perspective and to preserve the self. However, this strategy challenges educators’ assumptions that learners who deflect are avoiding personal responsibility. The authors’ findings raise questions about what it means to be resilient, and how assumptions about learners’ responses to failure may affect strategies to support underperforming learners.

K.A. LaDonna is assistant professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

S. Ginsburg is professor, Department of Medicine, and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.

C. Watling is professor, Department of Clinical Neurological Sciences, scientist, Centre for Education Research and Innovation, and associate dean of postgraduate medical education, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Funding/Support: Funding for this work was awarded by the Academic Medical Organization of Southwestern Ontario.

Other disclosures: None reported.

Ethical approval: All study procedures were approved by the Western University Research Ethics Board.

Previous presentations: Earlier iterations of this research were presented at the Canadian Conference on Medical Education, April 16–19, 2016, Montreal, Quebec, Canada; at the International Conference on Residency Education, September 30–October 2, 2016, Niagara Falls, Ontario, Canada; and at the International Conference on Residency Education, October 19–21, 2017, Quebec City, Quebec, Canada.

Correspondence should be addressed to Kori A. LaDonna, Department of Innovation in Medical Education and Faculty of Medicine, University of Ottawa, 850 Peter Morand Cres., Room 102K, Ottawa, Ontario, Canada; e-mail:; Twitter: @Kori_LaDonna.

Copyright © 2018 by the Association of American Medical Colleges