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Assessment of Stress Effects on Cognitive Flexibility using an Operant Strategy Shifting Paradigm
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The shift from disbelieving underperformance to recognising failure: A tipping point model.

Andrea Gingerich1, Stefanie S Sebok-Syer2, Lorelei Lingard3

  • 1Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada.

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Summary

Supervisors recognize a trainee needs to fail after accumulating incidents, discovering errors, or through external input. This recognition, often accompanied by anger, signifies a critical tipping point in performance assessment.

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Area of Science:

  • Medical Education
  • Physician Supervision
  • Trainee Assessment

Background:

  • Supervisors face challenges in failing trainees despite assessment redesigns.
  • Reluctance to engage in failure-related assessment processes persists.
  • Understanding how supervisors recognize the need to fail a trainee is unknown.

Purpose of the Study:

  • To explore how supervisors recognize when a trainee needs to be failed.
  • To identify the patterns and emotional responses associated with recognizing failure.

Main Methods:

  • Constructivist grounded theory methodology.
  • 42 physicians and surgeons in British Columbia, Canada were interviewed.
  • Iterative, constant comparative process used to identify themes.

Main Results:

  • Three patterns of recognizing failure: incident accumulation, egregious error discovery, or external illumination of deficits.
  • Recognition of failure was associated with anger, certainty, and a sense of duty.
  • Emotions like anger may drive, rather than hinder, failure recognition.

Conclusions:

  • Recognizing failure is a psychological tipping point, shifting from disbelief to certainty.
  • Anger's role in failure recognition warrants caution, as it may impede improvement detection.
  • Findings suggest supporting earlier identification of underperformance and overcoming reluctance to report failure.