Anesthesiology Residency: Understanding the Role of Failure

To the Editors:

Anesthesiology residents often struggle to comprehend the role of failure in their professional development. Many of these young professionals, particularly medical students, have been raised or coached in a “success-oriented” microcosm where failure is stigmatized, and the idea of making mistakes is often met with fear, avoidance, and shame. This mindset can be particularly prominent among high-achieving individuals who have been conditioned to associate success with self-worth. Consequently, trainees may view failure as a personal defect rather than an opportunity for growth and learning.¹ There is a pressing need to shift this perception and foster an environment in which failure is recognized as a crucial part of the journey to becoming a competent anesthesiologist.

The culture in which we train our anesthesiology residents is fundamental to shaping their career trajectory and the professional values they uphold. Anesthesiology training programs must teach our residents the crucial role of failure, as well as resilience.

Failure is widely acknowledged as an important component of creative and innovation endeavors, of building a business and navigating marketplaces. For obvious reasons, failure has not been embraced in medical education/training, as it would be morally inadmissible to jeopardize our standards of patient care and patient safety. Although academic physicians have long found ways to supervise and teach while “first, doing no harm,” the culture of medical training either outright shamed weaknesses, or at a minimum treated failures as secrets to be swept under the rug. We have an opportunity to change these unhealthy customs.

Residency programs must promote a culture in which we embrace failure as a teaching tool rather than a setback.¹ Training programs can create a culture that consistently supports residents as they navigate through their mistakes, and can create a safe and open training environment in which trainees’ failure is within a system of extensive safety nets, where their failures do not reach patients or jeopardize safety. It is through this perspective that we stimulate the development of experiential skills, equipping anesthesiology residents with the capacity to navigate professional challenges.

It is also essential for anesthesia residents to understand and embrace the role of failure in their professional development. Like the world's best athletes, where even premier basketball players make only 50% of their shots and elite baseball players have a batting average of 0.366, anesthesiology residents should recognize that they won't always achieve a perfect outcome. Just as athletes use their missed shots or strikes to refine their techniques and strategies, residents must also learn from their mistakes and failures. These instances are not indicative of incompetence but are valuable opportunities for growth and improvement. It's through these experiences that residents can evolve into skillful anesthesiologists, capable of handling the complexities and unpredictability inherent in medical practice.

As professional anesthesiologists we set the example prominently with morbidity and mortality conferences that highlight the mistakes that can be made by even the most knowledgeable and skilled anesthesiologist. The discussion that is sparked in these conferences is extremely valuable to the trainee as they see how “failure” is approached at the next level. Being mindful of how we treat each other and the tone that is used is important when residents reflect on their own missteps.

Environments that solely focus on success discourage exploration and expansion beyond the boundaries of current knowledge and skill. By destigmatizing failure, it is possible to reframe these moments as learning opportunities. Residents must be encouraged to understand that failure is an inherent aspect of the learning process, offering invaluable insights that success may not always yield.

After experiencing failure, it is essential to learn how to interpret these ostensibly adverse events and learn how to bounce back. Resilience is a crucial attribute for every anesthesiologist. Training residents to be resilient equips them to manage the demanding and often unpredictable nature of the profession. Cultivating resilience enables residents to handle setbacks and stress effectively, empowering them to recover stronger and more determined.

Instead of fearing errors, residents feel empowered to confront them, learn from them, and enhance their skills and judgment. Experiencing failure allows residents to develop essential experiential skills that contribute to their professional growth. Professional and personal confidence develops following these events, when a resident appreciates the work they put in to overcome those obstacles.² These experiences offer trainees a profound understanding of patient care and enhance their decision-making processes, ultimately shaping them into better anesthesiologists.

Learning to endure and overcome such challenges is a vital aspect of professional development. Residency programs should equip residents with growth strategies to navigate difficult situations. By advocating a culture that values failure and resilience as a part of development, we build an environment in which residents feel encouraged to take on challenges and grow as professionals.

As academic anesthesiologists, we have the opportunity to shape the minds and career trajectories of our future colleagues. Professional adversity is a reality that anesthesiologists will face during their careers, and embracing and growing from failure is critical to professional development. Residents must be encouraged to understand the role of failure and resilience, and of the invaluable insights that success may not always yield. Although we may not always appreciate “missing a shot” in the moment, it provides us with a valuable lesson on how to successfully make the next one.

Funding Statement

Financial disclosures/funding: None