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Shifting and Sharing: Academic Physicians' Strategies for Navigating Underperformance and Failure
Kori A LaDonna1, Shiphra Ginsburg, Christopher Watling
1K.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.
Physicians cope with underperformance by shifting focus or sharing blame, a strategy that may preserve self-awareness but challenges educator assumptions about learner insight and resilience.
Area of Science:
- Medical Education
- Physician Well-being
- Professional Development
Background:
- Medical practice is inherently complex and uncertain, leading to inevitable underperformance and failure.
- Physician coping mechanisms, insight, and resilience are crucial for navigating these challenges.
- Understanding how physicians develop and utilize these skills is vital for supporting learners and practitioners.
Purpose of the Study:
- To explore how academic physicians develop and use insight and resilience to navigate underperformance and failure.
- To identify strategies physicians employ to cope with professional struggles.
- To inform support systems for struggling learners and stressed practitioners.
Main Methods:
- Qualitative study utilizing constructivist grounded theory.
- Interviews conducted with 28 academic physicians regarding experiences with underperformance or failure.
- Data collection and analysis informed by grounded theory principles.
Main Results:
- Physicians' struggles varied from significant errors to interpersonal conflicts and work-life imbalance.
- Coping strategies included shifting focus to successful identity aspects and sharing accountability for failures.
- Participants perceived learners using these strategies as lacking insight, despite their functional and protective value.
Conclusions:
- Distributing responsibility for underperformance can be a protective and functional coping mechanism.
- Shifting and sharing responsibility may be linked to reflection and resilience, aiding self-preservation.
- Educator assumptions about learner deflection may hinder effective support strategies for underperforming physicians.