#KeyLIMEPodcast 258: I’m a loser, baby! That’s why I’m outperforming you

Reference

Klasen et. al., Allowing failure for educational purposes in postgraduate clinical training: A narrative review Med Teach. 2019 Nov;41(11):1263-1269.

Reviewer

Lara Varpio (@LaraVarpio)

Background

• Clinical training is: “strongly predicated on the notion that learners will engage in activities at the edge of their clinical competence in order to develop necessary skills for future independent practice”
• If we are making our learners work at the very limit of their competence, then they will inevitably fail
• The question that then begs to be answered, then, is: what is the role of the educator in relation to failure for learning purposes? Can we harness failure for learning?

Purpose

• The authors conducted a narrative literature review to explore the postgraduate medical education literature for existing knowledge of the when, why, and how failures are used for learning

Key Points on the Methods

• The authors started with a non-comprehensive scan of the literature, doing a hand search for articles on “allowing failure” and “learning from failure” in GME and other fields. This generated 16 papers of which they kept 7. This contributed to a second arm of review which was a more focused search in PubMed for specific MESH terms that found 612 paper of which they kept 13. They did an additional hand search of the references of selected papers which added another 6 papers to their review.
• The authors developed topic-related categories reflecting the main insights of the chosen papers and built relationships among the categories. Using concept maps and synopses, they made sense of the of the findings related to each other and overall how they informed their research topic

Key Conclusions

• The authors identified 41 articles for the full review – but none of them directly addressed the phenomenon of clinical supervisors allowing residents to fail for educational purposes. But they did find 4 related topics in the literature.
• First, several articles were identified as characterizing the errors that residents made during clinicial activities, addressed frequency of these errors, the types, and some causes of those errors, the impacts of those errors on residents, and approaches for teaching around error.
  • But then the discussion of approaches for teaching around error talked about the need for a safe learning environment if educators are going to harness the power of learning from mistakes. It requires explicit discussions between learners and supervisors, and constructive feedback. But none of that addresses the fact that the errors were made because the residents are overworked and tired.
• The second area of knowledge the authors identified was around learning from failure in clinical practices. They focused on the emotional responses of practicing physicians when they make errors and their coping mechanisms
• The third topic addressed the educational value of failure as it is discussed in settings outside medicine. Interestingly, while business, education and sports psychology discussed that failures could be passively allowed, there was little discussion of how supervisors might actively allow or promote failure for learning
• Finally, the authors identified patient safety considerations and their implications for learning from failure, specifically addressing the patient safety culture in medicine. They noted that residents, supervisors and organizations have different perceptions of patient safety culture and practices

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