Rediscovering Failure
When was the last time you experienced true failure?
Most health professionals are high achievers, myself included. So much sacrifice and determination is necessary to simply get into a health profession program, let alone complete your training and sustain a career. If you're anything like me, you fail-proof your decisions, contemplate contingences, and avoid making the same mistake twice. You've probably learned over the years to avoid the things in which you are less likely to succeed. We've conditioned ourselves to success. I wonder if we, as seasoned practitioners, find it hard to empathize with newer professionals who are experiencing failure, because we haven't failed at something important in a very long time.
I recently rediscovered failure and the emotions it creates. This past summer, I decided to thru-hike the Colorado Trail and its 500 miles of countless crossings of the Confidential Divide and numerous unnamed mountain passes. On the fifth day of what would become a seven-week journey, I was caught in a severe thunderstorm as we climbed down from a pass. I knew bad weather would happen on the trail and I thought I had prepared well for storms, but I was wrong. I hiked in hail and lightning trying to reach a suitable campsite. I could feel water drenching through my rain gear and soaking through my backpack. Anxiety was mounting. This wasn’t like I had planned.
At camp, I discovered my biggest fears were true: my warm clothes, tent, and sleeping bag were soaked. I was already shivering, and fear of hypothermia formed on the edges of my mind. Not only had I failed, I placed myself at risk. I required twice the normal time to set up my shelter as my numbed fingers failed to work. Once inside the tent, I felt water dripping down on me from every seam. My inflatable sleeping pad felt more like a pool raft, keeping me above the wet floor of my tent. I had to humbly rely on other hikers for extra layers of dry clothing and asked them to retrieve water in the rain for me so I could have a hot meal. I spent the rest of the night in my tent contemplating if I should go home. The only thing I could do that night was cover for warmth, journal, and think while waiting for the storm to pass.
The next morning, we stayed at camp to dry our gear in the sun. The day turned into a beautiful sunny summer day, perfect for a long hike. But my anxiety was too high, and I wasn’t prepared to continue and risk another night of wet cold if I encountered another storm. I was defeated and felt like I needed to leave the trail, get better gear, and withdraw into my risk-avoidant nature. When the trail crossed a road, I split from my newly formed group and began the journey of hitchhiking back to Denver.
Drying out gear the morning after a storm. Thru-hikers jokingly refer to this as “yard sales.”
As soon as I was back in the city, I put all my anxious energy into shopping for new gear, repacking, and returning to the trail. Within 24 hours, my spouse was driving me back to the mountains to pick up where I left off. This time I had a new tent, new rain gear, and a new strategy for staying dry, though in my haste I did leave behind essential things like my camp spoon and breakfast meals- new problems to solve another day. As we parked along the forest service road, tears flowed uncontrollably down my face. I'm not accustomed to crying, and I was shocked to find my composure betraying me. Apparently, new gear does not come with new confidence. What I was struggling most with at that moment was reconciling my own anxiety. I had internalized my experience on the trail during the storm as a massive failure. I could fail again, perhaps maybe even with a worse outcome next time. I felt stupid for even considering trying to finish the trail. I doubted myself.
If Success creates Confidence, Failure creates Self-Doubt
Looking back at my hiking journal from the night of the storm, it is clear to me I was swimming in a sea of self-doubt. Was I in over my head? Why did I think I was prepared to hike 500 miles when I couldn't make it past mile 60? Wouldn't the smart decision be to simply stay home? Why is this hike so important anyway? My fears and anxieties were at odds with my ambition and my desire to get back to the simple act of hiking. Every emotion was co-existing in an internal storm of confusion. Thankfully, I had more clear-headed friends and family encouraging me to complete this journey. Not returning to the trail would have been the true failure I wanted to avoid. Ultimately, I continued on to finish the trail several weeks later and emerged a much better version of myself. However, I don't want to overlook the fact that it literally took hundreds of miles and several days of hiking in rainstorms before I could let go of the fear and anxiety created by this failure. I felt the weight of this failure like blisters on the soles of my feet.
Since returning home, I have come to recognize my experience failing on the trail was a small taste of what my coaching clients experience when they fail a rotation or course. I also realized that my struggle with this failure may also be a reflection on how well I've avoided failing over the last several years. Yes, I've been frustrated and burnt out with work. I've told myself I've failed at times, but I've not felt it like that night caught in the storm. I was out of practice at failing and this moment reminded me how hard it can be to be resilient.
Success vs Failure
Over the years, I’ve thought deeply about student success and failure. In fact, this was the focus of much of my scholarship and research during my time as a pharmacy school professor. My hypothesis is that students rarely fail for the reasons I would often hear espoused by faculty members, namely that the student wasn't a good student, didn't try hard enough, or was underprepared. These reasons don't describe the students I've worked with during my time as a remediation coach, taking referrals from schools for students who have failed a rotation. The more recent reasons contributing to students' failures include untreated depression, loss of medical insurance, a diagnosis of cancer in their family, intimidating preceptors, and pre-occupation with financial obligations. None of these were a direct reflection of the student’s commitment to doing well nor their baseline competency. I'm confident my students would have done well had it not been for these circumstances that were out of their control. In short, the student who fails due to being underprepared or disinterested is far less frequent.
Despite the variety of reasons contributing to a student’s failed rotation, my conversations with them are often very similar. They express self-doubt, fear of risk, distrust of the system (the school, preceptor, faculty, etc.), and extreme confusion. These emotions can make working with future preceptors and faculty members incredibly challenging. They also prime students for repeated failure. I do my best to help them tackle each of these emotional hurdles.
Advice for preceptors working with students who have "failed"
If you're working with a trainee who is trying to bounce back from a failed rotation, I encourage you to be mindful of the self-doubt they are experiencing. Meet them where they are, likely in a self-fulfilling cycle of anxiety and distrust of the strategies they once relied upon. Students may need help recognizing whether to adopt new skills or re-test the skills that have previously associated with success. This may not be the time to be hyper-critical. The best thing you can do at this moment is provide your learner with clarity.
Recognize the fear of a second failure may be leading to them to underperform. This is not an indication of lacking motivation, rather this may signal a fear of risk. Students may be internally asking, "Can I risk being wrong again?" Remember we trained students never to be wrong and never to guess, so they are likely to rely heavily on the "Let me look that up" and "I don't know" responses - even when they likely do know the answer. Consider informing students when it is safe to think aloud and be wrong or when accuracy is necessary.
Pointing out a mistake may be enough to bring awareness and create change if the student understands how to avoid such a mistake. However, knowledge or skill deficits require new understanding or new tools. Preceptors who are quick to point out mistakes but do not offer mitigation strategies may be contributing to confusion. Without clear guidance, a student is left to experiment until they find a strategy that leads to success. Like all experiments, this is not going to always work well.
Reflect on how you are engaging with your learner. Are you contributing to their sense of self-doubt or are you providing a path forward? Are you helping them identify which skills are helping and which skills are hindering success? Recognize the importance of confidence post-failure and keep in mind it may take some time to shed the weight of a major failure.
Be the preceptor your student needs you to be!
Last, don't give up on your student! Anticipate your learner is going to be confused and likely frustrated. Which means you are likely to become confused and frustrated by them. This may require more patience than you typically need as a preceptor, and possibly a new precepting skillset of your own. Find the support you may need, whether it’s from the student's pharmacy school program or peer preceptors. This can be a new opportunity for you to grow as a preceptor and as a mentor.
I’m not sure I would have finished my trail had it not been for my spouse and my trail family. These people never treated me like I had failed. They were confident that I was capable of meeting this challenge when I was doubting myself. My challenge however did not include patient care, student debt, or a professional degree, stakes that spouses or friends of students may not be able to understand fully. In their absence, you as a preceptor may be the most qualified person to offer encouragement to a student when they need it most. Helping them navigate the self-doubt after failing a rotation may be your most valuable intervention as a preceptor. Likewise, seeing a student succeed after a failure can be one of the most rewarding experiences of a precepting career.
Crossing the highest point of the trail on a tree-less, cold rainy day with wind and hail, about 5 weeks after my gear failed me in a massive rainstorm.