The seeds of emotional turmoil inherent in medical education are planted early in the pursuit of becoming a doctor. It is the unspoken fear that medical students and residents experience each day on attending rounds.  It is the worry of missing a vital piece of information from the history and physical exam of a patient. It’s the concern, that despite reading and preparing for the cases, emerging physicians may find themselves in front of the team of doctors, nurses, and even patients without the answer to an attending’s question.  It’s the frustration of figuring out how to direct your own learning, so you are perceived as knowledgeable and confident by attendings, co-residents, and nurses.

This fear, worry, concern, and frustration become the backdrop for physician-directed learning.  While some doctors are able to quickly synthesize information revealed by a patient’s history and physical and develop a differential diagnosis to guide tests and treatment plans, other doctors succumb to the negative effects of the fear and frustration.  Instead of feeling inspired to learn, this gap in knowledge and clinical skills chips away at a medical student or resident’s confidence leaving them feeling discouraged and defensive.  Rather than taking the initiative, they hide out in the busy work of the day.

How do aspiring doctors thrive under these conditions?  What needs to shift so they can use the gaps in knowledge and skill as motivation to take charge of their learning, build their confidence, and own their expertise? How do we learn to support one another in the gap with compassion and not comparison?

And more importantly, how do doctors detach from the negative connotations of not knowing that cripples so many?

Learning does not end in medicine.  Evidence-based medicine requires medical professionals to remain current on the latest research and guidelines that direct patient care.  Doctors have to become comfortable with using their gaps in medical knowledge, clinical skills, and interpersonal skills as the template for developing their core curriculum, personal strength, and fortitude.

1. Detach from the negative emotions of not knowing. Instead of becoming overwhelmed when uncertain about the direction for patient care, ask yourself, “ What can I appreciate about this situation?”  Acknowledge the information you have then ask what additional information will help guide the diagnostic process?  Who can help you fill in the gaps in information and knowledge?  Learn how to ask clarifying questions of patients and their families to better understand the progression of their chief complaint.  Based on the history and your present medical knowledge formulate questions that demonstrate your understanding and will reveal the next steps.

2. Suspend comparison. No two medical students, residents, or physicians have the same experiences or journey in medicine.  Unfortunately, we often forget this and fall victim to the ills of comparison.  Comparing your success with the success of your peers often leaves you feeling like you don’t measure up.  From the outside looking in, the progress of others is more evident than your own.  They appear smarter, seems to have more confidence, have a better bedside manner, and do better on exams.  These perceptions zap your confidence, as you feel inferior to other residents. Break the cycle of comparison. While acknowledging their medical knowledge and skill, acknowledge and appreciate your own as well.  Learn to have a healthy respect for your own journey and look for the clues to fill in your gaps in knowledge and skill set so that you are always in learning mode.

3. Use your knowledge and skills as the foundation to build on. This allows doctors to feel confident as they interact with patients, nurses, and other members of the interdisciplinary team.  The more involved residents are with their patients, the more knowledge they obtain as well as exposing the areas to learn.  Residents will discover and develop a plan to read more, to participate in procedures, and have the confidence to ask questions of consultants and members of the interdisciplinary team as ways to fill in their gaps in knowledge and further contribute to their overall medical education.  Medical students and residents become less preoccupied in not knowing enough and enjoy the learning process with a positive attitude.

It is time for medical students, residents, and physicians at all stages of their careers to feel good about themselves in the learning process.

Stephanie Wellington is a physician and can be reached at Nurturing MDs.

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