The arc of failure: how medical students move through self-perceived failure in clinical training

Failure is inevitable in medical training, yet what comes next remains poorly understood. This study examined how fourth-year medical students experienced self-perceived failure and moved through recovery or sustained distress.

Between November 2023 and February 2024, 20 fourth-year medical students at a single private, urban, allopathic medical school in the United States completed semi-structured interviews. Using reflexive thematic analysis, the research team coded transcripts inductively and interpreted findings through the lens of Transformative Learning Theory.

Students described failure as a recognizable arc: an event, a response of shame, a period of processing, and a transformation in how they understood themselves as learners. Three domains shaped how students moved through this arc, stalled, or recovered without transformation. Personal intrinsic factors included the identity, mindset, and support that students brought to the moment. The immediate clinical environment, through team relationships and dynamics, steered students toward recovery or stalling. The broader external environment set the bar at which students perceived themselves as failing. We developed a conceptual model that situates the failure cycle within these three domains and maps the arc onto Transformative Learning Theory.

Failure can be transformative in medical training, but only under the right conditions. Personal factors alone helped students survive failure. Whether students transformed depended on their clinical teams, who could offer safety, feedback, and a meaningful role. The broader external environment, meanwhile, set the stakes of failure itself.