Thursday, 24 October 2013

The success of failure

Sim centres around the world have routines for when participants first arrive. Perhaps a sign-in sheet, distribution of parking permits, directions to the nearest toilets, refreshments, etc.

Most sim centres will also have a period before embarking on scenarios which includes looking at (or setting) the learning objectives and talking about confidentiality. This period helps to create the safe learning environment which will allow the candidates to perform without fear of reprisal or ridicule.

During this "setting the scene" period I talk to the candidates about failure and say something along the lines of:
"We are all human. We all make mistakes. You will make mistakes today. That is alright. I have made some spectacular mistakes in my clinical practice which have resulted in patients being harmed. I have learned from these mistakes and am a better practitioner as a result.
We are all here to learn from one another and I'm sure you would much prefer to make a mistake here on a mannequin, who will not die or come to harm, than on a real patient."

The problem with participants... with all of us... is that we don't like failure. In fact, we actively avoid situations where failure is an option. Youtube has a plethora of "fail" clips. Cats failing to jump high or far enough seem to be a particular favourite. Although they can be humorous, perhaps the viewpoint should be that these cats are trying something, failing at it and then learning from it. And that persistence often pays off.

Perhaps there are still places where failure is not seen as failure? In this very readable Inc. article about cadets at the United States Military Academy at West Point, the author Jim Collins talks to some of them about failure. Their responses:
"It's better to fail here and have other people help you get it right than to fail in Afghanistan, where the consequences could be catastrophic"
"Here, everybody knows it's a learning experience"
Collins goes on to claim that repeated failure is built into the West Point culture. Currently our education system and our medical training system is not rewarding or encouraging of failure. Big summative tests at the end of periods of training allow you to advance (or not) to the next level. In terms of education and training, what would happen if there were a test on day 1, where everybody fails and then repeated tests throughout the year to show you how you are doing and where your strengths and weaknesses are?

In terms of the simulator I am not a believer in the idea that the participants must fail in order to learn. (This is the "they're doing really well, let's throw in an 'anaphylaxis'" school of thought.) I think if the participants shine then we can all learn from that. But perhaps we should be more positive about failure, build it into our simulation centre culture and show how failure can be a success if it makes you better. I leave you with two quotes. The first a youtube comment on one of the cat "fails" and the second from Tommy Caldwell, a rock climber who features in the above-mentioned Inc. article
"This is not a fail. This is an Epic try!" - Dio Rex

"(Failure) is making me stronger. I am not failing; I'm growing." - Tommy Caldwell

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