Through my work in postgraduate medical education and as a clinical supervisor, I have had the opportunity to hear many stories about the struggles of resident physicians. I think that every time I hear a story from a resident, I momentarily flip back to my own residency training. I often think to myself, if I were a resident now, what would I do differently? The one thing that I know I would do differently, now that I know, would be to try to move forward and learn something after every negative experience.
I have heard many residents say for example, “I had a negative encounter with the family of a patient on the ward, but I just have to forget about it, move on and get through this rotation.” I am pretty sure that I reacted that way as a resident too, burying the negative incidents and clutching tightly the positive interactions that affirmed my belonging to the medical profession.
After years of being a supervisor, plus studying medical education, plus reflecting on personal change, I can see now that this approach wastes a valuable opportunity for learning and improving one’s professional practice. The negative experiences in residency (and even positive experiences) are in fact “critical incidents” in medical education. The examination of a critical incident, paired with reflection can promote change. But this won’t happen if we are encouraged to bury or gloss over these incidents.
I remember venting to my fellow residents, commiserating really. But I don’t remember anyone ever suggesting or asking: what could you have done differently? I would hear the same thing from my peers and faculty: residency is tough, the same thing happened to me too. A critical incident in fact, is a powerful catalyst for change, for improvement in skills, and for promoting positive behaviours.
The barriers to using these incidents to learn, and promote change, are many. Residents need time to sit and reflect on these incidents. Residents need not to be ashamed of negative experiences, wishing that the incidents would just go away. Residents need mentors that will show them how to move forward and see the transformative potential in these incidents.
I wish I knew then what I know now. But now I know and every negative encounter or ‘bad day’ (and often there are many) brings the opportunity to move forward.
Reflections on negative interactions especially have the potential to promote compassion. “The patient’s family was angry with me,” is an example. One could bury it, say patients don’t appreciate us and move on. But no, there is a better way. Stop and think – what were they looking for? What was missing in their view? Attention, explanation, compassion or all of the above? Reflection on incidents like this gives us the tools to handle the next incident and many more. I know that now.
What will you do the next time you are faced with a critical incident?
– Mala Joneja, May 2015
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