“You will make mistakes – and that is normal”
28 September 2018
Point of Care Foundation Associate Joanna Goodrich writes on the findings of our work looking at the teaching of professionalism in UK medical schools.
Everybody knows you can’t be perfect. Yet medical undergraduates, and indeed doctors, are living with the perception that they are expected to be perfect, and that anything less than perfection is not good enough. Removing this misperception would have a huge positive impact on medics’ wellbeing. This was one of the key findings from our medical professionalism project, which we are today sharing with the Medical Schools Council‘s meeting in London.
With Schwartz Rounds now taking place for undergraduates in some medical schools, we became interested in whether and how the teaching of ‘professionalism’ covers reflective practice and other aspects of learning resilience and self-care.
An audit of the 33 UK medical schools, which we commissioned with funding from Roche, revealed that the teaching of medical professionalism is inconsistent, with different emphases, ideas and methods across the schools. In fact there was quite an extraordinary variation in inputs to teaching professionalism in terms of time and a dedicated place on the curriculum, and there were no standard materials used for teaching. This means it is impossible to say with any certainty what medical undergraduates will learn about professionalism, including wellbeing and resilience. We believe this is a problem, given what we know about their levels of anxiety and the rate at which medical students are leaving before qualifying.
Recommendations for medical schools
Following the audit, we convened a workshop with medical students to collaboratively develop principles for how these topics should be taught. From this we have produced recommendations for medical schools, teachers of professionalism and the Medical Schools Council.
Medical students talked about the feeling that “everyone is expected to be very special” – which leads to all sorts of problems. When asked what a guiding principle should be for the teaching of professionalism in medical school they made a strong case for the overriding message to be “You will make mistakes – and that is normal”. They would then be less likely to punish themselves for not achieving perfect grades, and would not suffer from the ‘imposter syndrome’ which many described. Discovering that doctors have feet of clay came as a relief to many, and they urged medical schools to think about bringing in doctors to teach who would be able to talk about mistakes they had made, and how they overcame them and went on to be successful. These would be the most valuable role models.
Medical students talked about the feeling that “everyone is expected to be very special” – which leads to all sorts of problems.
We also make other recommendations:
Teachers at medical school need to have skills in creating a safe space for students to learn, so that they can learn to share thoughts and reflect openly about their experiences. This helps to promote insight into self and others as iterative process, and works best in small groups.
Experiential approaches which ground learning in real life are valuable. We heard about medical students at Southampton who all have to work shifts as healthcare assistants; this not only gives them an insight into life for patients on the wards they would not otherwise have, but helps them to understand their colleagues in other roles. Another recommendation – interprofessional learning – was to bring in teachers from other professional backgrounds as early as possible as tutors, lecturers and participants in small group work. Good examples of patients being involved were given, including their giving feedback to students. It was agreed that giving and receiving feedback is a skill that needs to be properly taught.
Awareness of cultural diversity among patients is covered in some professionalism courses. But at the workshop it was pointed out that students themselves are from diverse backgrounds. Students should be encouraged to be open and ask each other about their cultural beliefs and norms.
Students felt there was a lot of emphasis on unprofessional behaviour in medical school teaching. Many felt that a more positive approach that embraced professionalism rather than avoiding its opposite would be welcome. However, they did want guidance on how to identify unprofessional behaviours and their consequences, both for themselves and to enable them to challenge these behaviours in others. A final recommendation is that teachers and trainers in medical and foundation schools be required to reflect on how they act as role models and should foster open discussion internally about what professional and unprofessional behaviours look like in practice.
Teachers at medical school need to have skills in creating a safe space for students to learn, so that they can learn to share thoughts and reflect openly about their experiences.
There has been much in the news recently about doctors’ fear of punishment if they admit to making mistakes. Many are working in cultures where it is not possible to admit to being less than perfect, and it is not good if medical schools are mirroring this culture, even if not deliberately.
These recommendations, published in full on the GMC website, may appear to be common sense, but if they are consciously taken up so that there is no longer an uneven approach across medical schools, it could make a real difference for doctors of the future.