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Perfectionism in Medical Students Summary: 14.11.2019

By Srishi Agarwal, Second Year Peer Navigator • 14 Nov 2019 • 0 comments

This year, Medics4Medics started off the term with a discussion-based session on ‘Perfectionism’, led by Ahmed, a 5th year peer navigator. Perfectionism is complicated and multidimensional; researchers have categorized perfectionism into three types: self-orientated (adaptive and maladaptive), other-orientated perfectionism, and socially prescribed1 perfectionisms [1]. In a 2017 study [2], medical students presented with lower levels of socially prescribed perfectionism, and higher levels of adaptive self-orientated perfectionism (hypothetically related to admissions screenings). And somewhat unsurprisingly, maladaptive perfectionism was positively associated with anxiety and depression. The way we are assessed as medical students has changed substantially in the past 30 years. There is increased feedback and grading which affects how we think about academic success, as Clare Gerada (UCL alumni, previous Royal Society of GPs chair) points out in her (readable/short) BMA blog on perfectionism [3]. Perfectionism is not an easy topic to navigate, and so we’re glad you guys (or at least the students who voted in our bi- annual medics4medics poll) voted for it, and that we had the opportunity to begin a conversation about it. Medics across year groups attended the discussion, and casual feedback suggested that they found it useful. Here’s what we talked about:

Ahmed started the talk by asking everyone to think about a personalised definition of Perfectionism. We came to the conclusion that perfectionism tends to be associated with wanting to reach an ‘unobtainable goal’ where the perfectionist is never quite satisfied. What makes us, as future doctors more susceptible to perfectionism is perhaps the belief of higher stakes, and more pressure (both internal and/or external).

As a group, we then went on to think about how perfectionism develops. We considered reinforcement (positive and/or negative), competition (with peers/ siblings etc.) and relying on grades in particular, to develop a sense of self. Discussing our individual need to be a perfectionist, whether that be in academia or caring about what people think of you, allowed us the opportunity to share and offer advice to our peers.

I found our discussion on understanding how to ‘manage’ perfectionism the most useful part of the session. Although we did agree that perfectionism can have benefits - such as enabling the individual to be more disciplined or ‘successful’, it can sometimes be problematic. Perfectionists would do well discussing concerns with their peers, or seeking additional support if a concern prevents them from living their day-to-day life. Members of the group gave suggestions that had worked for them, such as ‘forcing yourself to fail’ in order to get comfortable with failure. One medic also gave the suggestion to think more about the various qualities needed to be a doctor- although competence is valued, as is a good bed-side manner and the ability to empathise with patients. In medicine, it is important to also think of the bigger picture, where the end goal is ultimately to become a doctor- what genuinely matters is always necessary to consider.

1 In case you didn’t want to guess how the authors defined each type, I copied & pasted definitions from the original paper (p457 for the fastidious): Self-oriented perfectionism: setting exacting standards for oneself and stringently evaluating and censuring one's own behavior. Other-oriented: unrealistic standards for significant others, places importance on other people being perfect, and stringently evaluates others' performance. Socially prescribed: involves the perceived need to attain standards and expectations prescribed by significant others, implies a perception that significant others have unrealistic standards for them, evaluate them stringently, and exert pressure on them to be perfect. Self-orientated can be good; motivating, adaptive, but also not so good; maladaptive. The latter two are broadly thought of as maladaptive, but have their perks too. It’s just one of a bunch of different ways to think about and measure perfectionism.

References:

  1. Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470. doi: 10.1037/0022-3514.60.3.456
  2. Seeliger, H., Harendza, S. Is perfect good? – Dimensions of perfectionism in newly admitted medical students. BMC Med Educ 17, 206 (2017). https://doi.org/10.1186/s12909-017-1034-9
  3. Gerada C. Unhealthy perfectionism. BMJ 364 (2019) https://doiorg/101136/bmjl438

What are your thoughts around perfectionism as a medical student? How has perfectionism affected you, and how do you react to perfectionism? What are your opinions on this form of posting? Share your thoughts in the comments ☺

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