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Eva’s Excerpt November 2019

“Success is not final, failure is not fatal: it is the courage to continue that counts.” Winston Churchill

In medicine and health professions training, we spend a lot of time and effort seeking perfection, or at least near perfection—high test scores, excellent grades, the “right” research project, the most impressive record of service, the best residency, the most competitive fellowship, all culminating in a successful career. We (appropriately) anguish over medical errors, even though we know that we are humans and, therefore, we are imperfect. None of this is bad or wrong. And yet, it can get in the way when we are trying to make change or innovate.

Recently, I was talking to a colleague about complex or ultra-large-scale systems. These systems are composed of many components which interact with each other and whose behavior is intrinsically difficult to model or predict due to the dependencies, competitions, relationships, or other types of interactions between their parts or between the system and its environment. Because of these complexities, failure or error is the norm, rather than the exception, and changes in one area cause unpredictable consequences in another area. So, it is extremely unlikely that all components of such systems are functioning perfectly at any one time.

Healthcare is a complex system and so is medical education. We certainly see in both of these areas that it basically never occurs that all elements of these systems are functioning perfectly at one time. In fact, one might even consider the job of any educational or healthcare administrator to be “chief problem solving officer”. I bring this up in my excerpt this month because many of us are currently working on large-scale change initiatives through curriculum renewal, residency program restructuring or changes, hospital restructuring/moves, and clinic operational changes. It’s a lot and we are all striving for it to go perfectly. This can sometimes stall us from making a decision or moving forward, “We just need more information or more detail.” Or, when the inevitable failure or error occurs, we beat ourselves up or point fingers.

I find this a fascinating contradiction to how we think about research. A recent conversation with Dean Perlmutter led me to this video interview of Bob Lefkowitz, Nobel Laureate, who speaks about the importance of failure to achieve innovation and find truth. In fact, there are pages and pages of quotes about the importance of failure in science as a critical step to learning and ultimately success.

So, I want to ask all of us to be okay with something less than perfection out of the gate as we move forward with these immense changes in medical education, our hospital, and system. We should all be prepared to fail in some ways. We should also challenge ourselves to learn from these failures, constantly growing, changing and improving along the way. Because, after all, Malcom Forbes said, “Failure is success, if we learn from it,” and isn’t this what we actually want to role model for our students, residents, and colleagues? Can we make a pact to be okay with some failures in the face of the unknown? Can we similarly commit to learn and strive to continually improve? And, maybe most importantly, can we promise to support and help each other through it? This is my commitment to our students, residents, and faculty: I can’t promise what I/we do will be perfect, but I promise to learn from it and keep striving to get it right.

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