Using reflection to confront mistakes:

This article is a reflection on how UQ Medicine student Raquel B. McGill turned a mistake into an opportunity by reframing her perspective, taking ownership and using structure to improve future planning.

I was completely blindsided. After an entire year of struggle, stress, and success, I failed my first year of medical school. I failed to submit an administrative form as part of an assessment – a simple yet consequential mistake. I could try to convince you that I was naïve, that I was not yet privy to knowing that seemingly small mistakes in medicine can be consequential. But that just wouldn't be true. 

My mistake resurrected memories of my grandfather's final years. He suffered an agonising deterioration and death from untreated cancer because of an unread Radiology report. The feeling of uncertainty and confusion about his declining health became a memento of the impact of simple mistakes. Nevertheless, I was in my first year of medical school and already slipping up.

I couldn't help but ruminate about how my mistake could have devastated someone's life if I were already a doctor. How could I forget such an important task? Am I even good enough to be here?

To make sense of my mistake, I started to reflect and write down my thoughts. It swung between disparaging thoughts about my incompetence and rants about how unfair the failing grade was and how inconsequential this mistake should have been. However, I realised that my ego was deflecting responsibility to save itself from the feeling of inadequacy. This was the juncture that highlighted how failures, when reframed, can be opportunities for improvement.

Meaningful reflection only comes when you are honest with yourself. Subconsciously we often engage in situations that make us feel comfortable and competent – inadvertently focusing on our strengths and neglecting our weaknesses. Honest reflection allows us to confront who we actually are and explore who we want to become. It is then that we can put our ambitions into action, not in spite of our deficiencies, but because of them.

In medical school, we are taught about the vulnerability of the patients we will treat and the importance of compassion. Yet, when it comes to ourselves, vulnerability and mistakes are often met with embarrassment and shame. Initially, I told myself I could not make a mistake again; I had to be perfect. However, work by Atul Gawande and Henry Marsh emphasise that despite remarkable individual ability, mistakes persist.

Accepting that mistakes and failures will happen and taking responsibility are part of the first steps to prevention. After my seemingly small mistake resulted in a failed course, I adopted a simple framework to retrospectively and prospectively think about mistakes – inspired by James Reason. It separates errors into three categories: factors that relate to the person, the environment, and the task itself.

Recognising complexity and potential critical points gives us the opportunity to learn from and prevent mistakes. Even so, despite the implementation of new habits and checklists I know that no matter how hard I try, I will make mistakes. I know that nobody is exempt from human fallibility – and that is nothing to be ashamed of, because it is how we respond that matters.

While I am not proud of my mistake, I am proud of how I responded. Mistakes are only really failures if you don't learn and grow from them. This opportunity forced me to explore my fallibility and the person I want to become. I can acknowledge that perfection is unrealistic and unattainable – but that doesn't mean I will stop trying. Because, through reflection, I discovered that the relentless pursuit of becoming the best version of myself is what counts.

This is an edited version of an article published in the journal Medical Teacher.  https://doi.org/10.1080/0142159X.2021.1967907