Being nice to medical students

A Positive Approach to Doctors-in-Training

“People have a natural desire to do good, physicians especially,” she said. “But the problem,” she continued, “may be a training system that encourages not how I can improve but how I can survive.”

Doctors-in-training, Dr. Reed maintained, want to know how to improve. But many of their teachers, individuals like myself who were exposed early on in their training to negative reinforcement, might not necessarily understand how encouraging rather than ignoring or discouraging might work in residency. Moreover, even for those educators who are comfortable with positive reinforcement, it is still not entirely clear which behaviors correlate best with professionalism and are thus most important to encourage.

Which is the reason why Dr. Reed and her colleagues chose to focus on only the most highly-rated residents in their study. “What is it about outstanding residents? And how can we all emulate and encourage that behavior?” she asked me on the phone. “We want to encourage residents and the behaviors that we know are associated with outstanding professionalism.”

Dr. Reed paused and then added, “Negative reinforcement is so defeating. There are far fewer people who need negative reinforcement than those who need the positive.”

Too often medical students, houseofficers and junior faculty receive no positive reinforcement.  I remember several situations in my development that aggravated me, because I knew that I had done well, yet I received no congratulations.  I also remember those who "patted me on the back."

Here is the problem, giving true positive feedback is much harder than giving negative feedback.  Too many physicians do not naturally deliver praise.  The entire process of getting into and through medical school is a test in individual resolve.  We use some external cues to gauge ourselves, but rarely do we get that positive encouragement.

Here is the trick – look for specific opportunities to praise.  When someone gives a good presentation, acknowledge it.  When they answer a difficult question, praise them.  When the team does a good job with a new admission, provide compliments.

We have to learn to pat people on the back, both verbally and sometimes even physically.  This article is most important.  I hope that the medical education community will absorb these concepts.