To the Editor:
Medical schools are changing their curricula and cultures as the evidence of student burnout and depression becomes increasingly harder to ignore.1 As a part of this shift, medical schools and students should work toward a culture change, fostering environments where learners feel they can be vulnerable, admit shortcomings, and identify knowledge gaps. The culture of perfection in medical schools currently poses a barrier to student wellness and development.
Excellence is attainable and sustainable. Perfection is neither of the two. The standard in medical schools of being faultless and flawless leaves students with the feeling that they are constantly falling short. In response, many students attempt to create images of perfection, which pervade the classroom, the library, and social media. Maintaining a perfect image is exhausting and can contribute to the burnout experienced by medical students. In a study of medical student perfectionism, socially prescribed perfectionism, the “perception that others expect a great deal of you and will criticize any signs of failure,” was a strong predictor of medical student distress.2
In the spaces where we feel we must be perfect, we hesitate to ask for help. When an attending asks if we heard a certain murmur during the cardiac exam, we are inclined to agree even if we did not hear it. When a classmate asks us if we understand the purine salvage pathway, we are compelled to say yes even if we do not get it. These are opportunities to learn, but due to the culture of perfection, they feel like challenges to our intelligence.
When we allow ourselves to accept flaws and leave behind the notion of perfection, we reach out for help when needed, improving our education and the delivery of patient care. Pursuing effective teamwork and health care delivery means identifying members of the group who possess the skills or knowledge we lack and learning from them. Students, administrators, professors, and attendings can all help foster a culture shift toward encouraging individuals to acknowledge what they lack. Empowering students to take risks and admit vulnerabilities will inspire students to be inquisitive and curious. Within this culture, we will be able to grow into excellent physicians.
Arianna F. Yanes
Third-year medical student, Northwestern University Feinberg School of Medicine, Chicago, Illinois; [email protected]; ORCID: http://orcid.org/0000-0002-7489-4452.
1. Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA. 2014;312:17251727.
2. Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ. 1998;32:456464.