In the past two weeks, there have been two social media posts, one from a resident physician and another from an attending physician, criticizing trainees. The resident was critical of a trainee’s inability to identify anatomical structures in the operating room, while the attending physician was entertained by a trainee who mistakenly wore a shoe cover as a scrub hat, with a photo of it included in the post. As of my writing, both posts have been taken down, presumably in response to the overwhelming backlash generated. Screenshots of both posts were taken and are still circulating, proving once again that nothing online ever truly disappears. Neither of the posts identified the trainees involved; the post with the photo shows the trainee from behind. No harm, no foul, right?
I don’t agree with this. I see harm in these posts, actually a lot of harm. Although neither identifies the trainee, assuming he or she has social media, they will easily be able to identify themselves. Likewise, those present when these events took place will also recognize the person involved. Even those who work at the same institution as the resident and attending physician may be able to identify the trainees. I remember when I was a medical student in the trauma service, and I proudly but incorrectly identified the border of the scapula as a pneumothorax on a chest X-ray. I was embarrassed in front of the team and my classmates, but by virtue of my current age, there was no social media at the time. No one could post online about “how dumb Jonathan was” or “how Jonathan clearly had to study more” to amuse the masses. Mistakes may have been occasionally retold later, but word-of-mouth is relatively inefficient and not accessible 24 hours a day.
What happens when people make a mistake? It really depends on how it is handled. If they are punished, embarrassed, ignored, or blamed, they may not be willing to take the risks necessary to learn and improve. If the mistake is made out of the view of others, those making them will only admit to the ones they cannot hide despite their best efforts. Learning suffers, engagement suffers, and the ability to fix mistakes early suffers. This is far from a new concept, and the importance of not doing this when people make mistakes has been the focus of psychological safety research and the best-selling book The Fearless Organization by Amy Edmondson. Psychological safety is, in part, the ability to make mistakes without worrying so much about what others will think of you.
Social media adds another dimension to it. These posts had been collectively viewed hundreds of thousands of times before they were removed. Let’s imagine that you didn’t know the trainee involved, but you saw the post, and you work at the same institution as the individual posting. Today you’re assigned to work with him or her. You might try to get out of it, maybe switching assignments with your colleague who isn’t as social media savvy and is unaware of the post. If you can’t wiggle out of it, you might not focus on your learning as much as you should; you’re instead focused on your missteps, actual or imagined. Maybe you might do or say something that is deemed worthy of posting and end up as the trending topic later that evening. Could those considering applying to training programs at the posters’ institutions be dissuaded because the programs may appear “malignant”? What about medical students elsewhere, wondering if their attendings and residents might embarrass them the same way? When things like this happen in the open, there is a ripple effect that can occur that often goes far beyond what the “offender” intended. What was perhaps intended as a harmless attempt at humor or an expression of frustration is perceived differently by others in ways not originally planned.
In astronaut Scott Kelly’s book Endurance, he quotes a Navy saying about mistakes: “There are those who have and those who will.” The bottom line is that we all make mistakes. Instead of what happened here, what if those individuals posted their own mistakes on social media instead of the mistakes of others? This could actually help create psychological safety rather than inhibit it. From a position of leadership, normalizing mistakes demonstrates humility. It releases the stigma from making them. It communicates to trainees that they can focus more on learning than worrying about what others think of them if and when they do something wrong. When I share my mistakes with trainees (like showing them my “pneumothorax” on a chest X-ray), it also signals to them that I’m not hung up on making them. Sure, I’d rather not make mistakes, but never making them is not an option. I’d rather someone point out a mistake to me before it causes something bad to happen. As I’ve grown accepting of my own fallibility, I think I’d still prefer not to read about them on social media unless I’m the one posting it there.
Jonathan Cohen is an anesthesiologist.
