Perfectionism: Addressing Lofty Expectations in Medical School

Perfectionism: Addressing Lofty Expectations in Medical School

Samantha Ilia Smith (West Virginia School of Osteopathic Medicine, USA) and Mitchell Dandignac (West Virginia School of Osteopathic Medicine, USA)
DOI: 10.4018/978-1-5225-2811-1.ch003


Perfectionism is the refusal to accept any standard short of perfect. Perfectionist students might strive for ‘faultless performance, meticulous attention to detail and high levels of competency' (Humphris & Kaney, 1998). In a field as complex and advanced as medicine, faultless performance is unrealistically expected. This chapter will discuss how the rigours of medical school promote perfectionistic behaviours in students. What is perfectionism? How does perfectionism in medical school affect students? How can educators and administrators identify perfectionism, provide psychoeducation, or address maladaptive perfectionism? How can students address perfectionism? It is essential to recognise perfectionism in medical students as research has shown that maladaptive perfectionism has been correlated to physician suicide (Scutti, 2014). The chapter concludes with recommendations on how students and medical educators can employ strategies to promote sound mental health and wellbeing during medical school.
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The negative impact of medical school on students' general and mental health been made clear by research (Voltmer et al., 2010; Guthrie, 1998; Dyrbye, 2005; Doherty & Nugent, 2011). The research found that, compared to students studying other subjects, or peers in the same age range, medical students face an increased risk of developing depression, anxiety, and burnout. Ahmed et al. (2012) and Prinz (2012), support the prevalence of these mental health issues. In addition to these significant mental health problems experienced after students begin medical school, other signs of distress are noticeable in the personality of some students, according to the research referenced above.

Studies documenting personality types refer to many medical students and doctors as having Type A personalities. People described as having Type A personalities may have higher rates of some health problems. For instance, Type A personality behaviour was first mentioned as a potential risk for heart disease by cardiologists Meyer Friedman and Ray Rosenman in the 1950s. Behaviours commonly viewed as being associated with the Type A temperament include excessive ambition, aggression, competitiveness, drive, impatience, need for control, focus on quantity over quality and unrealistic sense of urgency (Lipsenthal 2014). The personality type of medical students may have an important impact on both their academic performance and emotional adjustment during medical school (Turiano et al., 2012; Jerant et al., 2012; Plaisant et al., 2011; Friedman et al., 2010; Henning et al., 1998). Thus, when students who display Type A personality traits are exposed to the demands of medical school, they are more likely to develop maladaptive perfectionistic behaviours.

When examining the culture of medicine and medical education, a typical expectation is that medical students will perform at a high level and on a consistent basis (Hafferty, 1998). Striving for excellence and maintaining distinction are worthy goals. The hidden curriculum in medicine appears to shun students who do not live up to the firm beliefs that medicine is both rigorous and demanding, and that if students are not tough enough to handle these high expectations, then another career ought to be considered (Hafferty, 1998).

Medical students are expected to learn an immense amount of information, study for long hours, and pass a series of examinations designed to serve as yardsticks before being able to advance to the next course or phase of medical training. The pressures to constantly achieve may compromise the mental health of students, as well as doctors, who work to live up to high expectations from family, medical educators, the rest of the medical community and patients who all expect a high level of competence. The stress associated with trying to match or exceed these expectations often lead to the development of feelings of inadequacy (Bhatia, 2016). In the literature, feelings of inadequacy are often discussed in terms of the phenomenon known as ‘imposter syndrome’. According to a study conducted by Henning et al. (1998), strong associations were found between students suffering from psychological distress, perfectionism and imposter syndrome. Imposter syndrome occurs when students deemed high achievers chronically question their abilities to succeed and live in fear of being considered by others to be intellectual frauds.

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