“But it's 1%.” The words fell from my mouth like a lump of coal.
“I'm sorry, but the passing score was raised by 5% this year. You will have to remediate the course,” my instructor said, stoically. Remediation. The feelings the word raised were very painful and unexpected.
Failure was not something I was trained to handle. Having studied at an Ivy League college before matriculating to medical school, the worst I expected to be called was average among the best. In my world, “B” stood for “Bad,” and any grade below that meant another career choice.
I walked out of my instructor's office in a daze. If I had a tail, it would have been tucked between my legs as I walked home. I had just experienced the existential equivalent of a major painful blow, which I believed produced no externally visible wounds. Feeling embarrassed and ashamed, I chose to hide my failure, or so I thought.
A month into my next block, a friend tapped me on the shoulder. “Hey, what's wrong, you seem stressed.”
“I'm a failure, that's what's wrong,” I said in my mind. I considered telling my friend that I was fine. I figured it wasn't a lie because I was breathing unlabored with a regular rate and rhythm. Yet, there was something in my friend's voice that disarmed me. After a brief hesitation, I smiled halfheartedly, and said, “Come by my place tomorrow, and I'll tell you.”
I was watching the oven timer when the doorbell rang. Some people drink when they are anxious, others exercise; I bake. In fact, I had baked all day, and the bowl of cookies was visible evidence. I offered the cookies to my friend and opened up to him about my failure.
“How can I help?” he asked.
I stared at him in disbelief. “What?”
My friend smiled. “I think you're a perfectionist. Cut yourself some slack.”
This wasn't the first time I had been accused of being a perfectionist. When I was 10, my mother came out of my fifth-grade parent-teacher conference crying.
“Why are you crying? Did he say I was doing bad?” I gasped.
“No. Your teacher thinks I pressure you to be perfect, and I told him that's just how you are.”
Being a perfectionist did have its perks. My mother never had to nag me to clean my room. In school, my classmates always wanted me to join their group projects because of my “work ethic.” Giving 110% attention to the details had propelled me through undergraduate studies into medical school. It pained me to think that perfectionism might have contributed to my current failure, but my friend's kindness and insight convinced me to look a little deeper.
The next day, I baked an angel food cake and reflected on where I went wrong. The truth was, I had a hard time asking for help. Instead of using available resources and taking the risk of appearing ignorant, I often tried to figure things out on my own at the expense of efficiency. In medical school, there was too much material and too little time to spend hours trying to clarify a concept.
This “go it alone” attitude also affected my work with peers. As much as I wanted to believe otherwise, I was not a team player. People liked me on their projects because I did most of the work. Medicine being a team sport, mine was a crisis in learning, and I had a losing strategy.
Committed to turning my failure into a success, I did something I had thought to be a cardinal sin—I asked for help. Sharing what I knew and did not know with my instructors helped me become a more efficient learner and, in the process, a better team player. I resisted the urge to do all the problem-based learning questions on my own and trusted the answers provided to me by my classmates. This did require the impromptu baking of several batches of cinnamon snaps. At the end of the day, the cinnamon snaps took less time to finish and tasted a whole lot better than problem-based learning questions.
Feeling satisfied with my new insights, I shared some of the changes I made with my friend over coffee. He listened intently and asked, “So, how are you staying balanced?”
I sipped my coffee and cleared my throat. “I'm getting enough sleep.”
He laughed. “No, I mean, what do you like to do besides studying? If that's all you do, you're going to burn out.”
I took a bite of biscotti and chewed nervously. My friend was right. Before I began my medical studies, I wrote, exercised, and meditated daily. These activities brought me a lot of joy, yet I could not remember the last time I had incorporated them into my schedule. Persuaded that studying more would not ameliorate the weight of my failure, I promised myself to add wellness activities back into my daily life.
At first, I struggled to put my books aside, but as the academic year progressed, and I built on small successes, I felt healthier, happier, and humbler. I learned a new way of learning and became a better teacher in the process. And when the time finally came for me to remediate the course I had failed, I understood the material in a way that would not have been possible had my instructor passed me. Despite the pain of the transformation, a part of me was grateful. Sharing my failure made the difference.
All of us learn from experience, especially physicians. The question is not whether we will fail, but how we will face failure. This is something I have tried to teach medical students and other residents in my role as chief resident. I take part in administering resident remediation plans and offering feedback to my program's Clinical Competency Committee. I share my experience of personal remediation freely with my colleagues, knowing that the hardest part of “failing” is feeling that others do not understand your experience. To my surprise, as I have become more open about my academic obstacles, other so-called “perfect” colleagues have shared their own struggles.
Educational remediation remains 1 of the most difficult transitions I have faced in my medical career. Sharing my obstacles, rather than my accomplishments, has helped me inspire others through difficult times and has helped me grow into a better leader and physician. When I started medical school, I believed in the legend of the “perfect physician.” I never imagined I would say, “I'm a physician who failed, and I am better for it.”
The author would like to express his appreciation to the staff of the Department of Psychiatry, University of Hawai‘i at Mānoa.