Dr Prani Shrivastava – failing, shame, resilience and a growth mindset in specialty exams

Failing as a person and failing as a doctor were uncharted territories for me once. Now they inform my approach to work every day.

The first exam I failed was in my first year at UWA-Physics 101. I studied very differently for my supplementary exams that summer intent on never again having a capital F (for fail) or capital S (for supp) appear on my academic record.

Skipping forward to a few years later, the consultant Anaesthetist who interviewed me for the Anaesthesia training program warned me that the stress around exams and training was intense. I responded confidently that having failed exams before, I had learned how to study effectively and came from a close family who would be a tremendous support during the upcoming challenges.

The twists and turns that followed were unexpected. I got into two Anaesthesia training programs and elected to return to WA to specialise where I had a better support network. I enjoyed my first year of Anaesthesia training - the skill acquisition, the collegial support, the sense of efficacy – it felt vastly superior to the daily grind of being a resident or service registrar.

When the time to sit my primary exam arrived, my circumstances were now very different from my Anaesthesia entry interview; every family member had moved, and most were now overseas. A death in the family and a serious illness had led to stressful issues at home. I could no longer ‘just’ go home and focus on studying - I had other roles and responsibilities that seemed just as important as passing an exam. I was twice denied study leave at 2 different hospitals around exam time.

I had some supportive consultants (including examiners who encouraged me not to sit the exams during this period of immense stress). My friends were concerned but many were also on the same path – long hours, specialising, juggling relationships and life events. Eventually the juggling on the home front, the study front and work front came crashing to a halt. I failed my primary exams twice, my work performance deteriorated and I resigned from the training program. What followed was a pattern I have seen repeatedly in medicine after failing specialty exams. A period of confusion, battling a sense of failure and shame, mitigated by unexpected support and expert help.

My fellow trainees meant well but few of them could empathise and fewer had the time to support me. A few weeks after my resignation, I was persuaded by the supervisor of the training program to take as much time as I needed and then come back to training. I successfully sat my exams shortly thereafter. Eventually I completed desirable fellowships, I obtained consultant posts and many years later, was invited to apply to be an examiner for the final fellowship exam.

The greatest consolation to me was the number of bosses who empathised and had actually failed exams too! There was an outpouring of generous support from consultants who I had worked with, even those who hadn’t failed. It was eye opening that failing an exam wasn’t the defining event of my life personally or professionally. Two heads of department shared valuable advice which I return to repeatedly; one told me just because I had failed a test of physiology, pharmacology, measurement, and stats, didn’t mean I was a failure. Another said resilience is about what happens after failure and they were sure I would succeed. They showed greater faith in me than I had in myself.

I was recently reminded of this period when talking to my former supervisor of Anaesthesia training during a presentation we attended on shame and failure in medical education, which resonated strongly with both of us.

As a consultant Anaesthetist, I now fail every week. Whether it’s a difficult IV insertion, a stormy anaesthesia induction with a crying child or a workplace interaction where the dynamics are suboptimal. What I have learned is that blaming external factors solely isn’t going to help me improve, but neither is blaming myself. Not everything happens for a reason – failing exams made me a better student than I would have been but at a great personal cost. Trying means failing. Mastering anything complex and difficult will take hundreds of attempts. Failure can be leveraged in a constructive light and I hope I am getting better are doing it, after the emotions of failure subside. Whether it’s serious patient harm or serious personal cost, the results of shame can include the destabilisation of self-esteem, the impaired sense of belonging and potentially impaired empathy.

Not everyone who fails a professional exam will get the same level of support I received. Anaesthesia is a large community so more support is available. I encourage anyone in a similar position to seek help - I had a fantastic GP who had some anaesthesia experience was a skilled GP who also provided an empathic ear. The Doctors Health Advisory Service helped me find him at short notice the week I quit the training program.

Learning constructively after failure is hard. Shame, guilt and failure in medical education are becoming more widely understood. Every time we fail we owe it to ourselves to learn constructively, to delve deep into the emotions and allow them space. After unpacking them, we may find something valuable (using a growth mindset) that changes our trajectory a little. It might make us better physicians, better humans and hopefully less judgemental of others who fail - just like us. Everybody fails - not discussing it doesn’t erase it from happening. Our stakes are high and most of us will need support to cope.

I wasn’t the first to fail. I won’t be the last. Failure is a universal experience. Not all failure stories are stories of redemption. We will stop failing when we stop trying. We won’t know how good we can be unless we try. We deserve, our families deserve and our patients- deserve us dusting ourselves off and if we are ready - trying again.срочный займ с 18 лет безработным

Prani Shrivastava completed anaesthesia training in Western Australia in 2004 with fellowships at Princess Margaret Hospital for Children and Sir Charles Gairdner Hospital. She undertook a further fellowship in pediatric anaesthesia at the Royal Children’s Hospital in Melbourne. Her first Consultant post was as an Assistant Professor of Anaesthesiology at Seattle Children’s Hospital, before returning to Perth where she has been a Consultant Anaesthetist at Perth Children’s and Sir Charles Gairdner Hospitals since 2006. She has been an executive member and Chair of the Wellbeing of Anaesthetists Special Interest Group,CME officer for ANZCA WA and is currently an examiner for the ANZCA Final Fellowship examinations and a member of the steering committee for the Long Lives, Healthy Workplaces Toolkit. She has published in the field of doctors wellbeing. She is currently co-lead of the Wellbeing committee in the Dept of Anaesthesia at SCGH and a member of the Shape Our future committee at PCH among other roles.