The value of ‘struggle’ in medical training

Should we let medical trainees and residents struggle? That’s the question asked at one session at the 2023 International Conference of Residency Education in Halifax is mid-October. Presenters Dr. Emma Vaux, consultant nephrologist, physician and program director of Quality Improvement, at Royal Berkshire NHS Foundation Trust and Dr. Julie Johnstone director of Assessment and Special Projects for the Core Paediatric Residency Training Program at SickKids, gave the crowd several quotations and asked them to vote on whether it was on the topic of love or the practice of medicine. For example: “[XXX] should not make you feel like you’re walking on eggshells,” which was indeed about love. The audience was often divided as the quotes piled up. But when asked whether teachers should let learners struggle—regardless of how much—the majority of the audience agreed. The presenters then asked the audience to discuss this “wicked” problem among themselves. Some asserted that struggle is simply part of the fabric of medical training. “Of course there is going to be struggle,” one audience member said. One group asserted that struggle highlights the value of a team for the individual learner—noting that learners need to understand “if you try to do everything yourself you won’t have as good of an outcome.” This, they suggested ultimately strengthens medical teams. “What’s more important is what happens after the struggle,” said another attendee. Struggle should be seen as an opportunity for a learner to grow, but it’s only appropriate for it to arise in a supportive environment. Indeed, supervisors and teachers should demonstrate situations of struggle they’ve experienced. Another group emphasized that experiencing struggle pushes learners to develop frameworks they’re going to need to overcome future challenges. Struggle also, one group noted, demonstrates where people are in their development and learning, highlighting where improvement is needed. One attendee pointed out that an all-cost avoidance of struggle for trainees could create unfortunate instances of discrimination—for example, trainees working in their second language will likely struggle with communication at some point. “We need to bring in trainees who are much more likely to struggle in certain areas, for a while,” he said. But, there is a key distinction, one attendee pointed out, between struggling to develop a particular skill and struggling with an objectively difficult reality, such as being on call. He noted he struggles with procedures, so, “I try to put myself in situations where I’m forced to do procedures.” Another attendee sought to reframe the idea of struggle. “You can’t learn without challenge. But if you challenge someone and provide the appropriate support, they are handling a challenge,” rather than struggling—which is preferable, since the latter can lead to shame and burnout. On a less conceptual level, other attendees pointed out that it’s integral for patient safety to come before any potential insight a learner might get from being left to struggle with a problem.

The value of ‘struggle’ in medical training

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