Help Residents Battle the Downsides of Perfectionism

You can help residents manage “maladaptive” perfectionism.

Perfectionism often drives success...and is a positive attribute when residents use mistakes to strive for new heights.

But there’s a dark side. Residents can struggle with “maladaptive” or unhealthy perfectionism. In this case, they set unrealistic standards for themselves...and sometimes others.

When these impossible expectations aren’t met, residents develop deep shame and fear of failure. This can lead to anxiety, depression, and suicidal thoughts.

Residents who flourished in a structured school environment may not be able to maintain “perfection” in the new demands of residency.

Educate on maladaptive perfectionism during orientation and residency topic discussions. Encourage a “growth mindset”...believing intelligence and abilities can be grown...instead of a fixed mindset.

Share your own mistakes and struggles...and how they made you stronger and shaped your goals. For example, share presentations or papers from your early days to illustrate your growth journey.

Also stay alert for common signs of maladaptive perfectionism.

For instance, procrastination is common. Fear of imperfection can be paralyzing...due to an “all-or-nothing” mentality.

Help these residents break down projects into bite-size goals. Check in regularly...and celebrate the success of each step.

Lack of efficiency may be another sign. Trying to make things flawless can lead to long hours and missed deadlines. Suggest assessing or asking how long a task should take...and setting a timer.

Continue to balance positive and constructive feedback for all residents with a method like “ask-tell-ask.”

Watch for maladaptive tendencies, such as overly harsh self-assessments...or being defensive to constructive feedback, since it can be painful to hear less-than-perfect reviews.

If you identify maladaptive perfectionism, teach positive self-talk. Encourage keeping a “feel-good file” of current and past successes...or a sticky note reminder that their best is good enough.

Address maladaptive perfectionism in residents’ development plans to ensure follow-up is in place.

When you see concerns, connect residents with your Employee Assistance Program (EAP). Those with maladaptive perfectionism may not seek help...since they’re ashamed to share their flaws.

Use our Preceptor’s Guide for tools to help with teaching and communication, resident burnout and resilience, and more.

Key References

  • Int J Med Educ. 2020 Sep 28;11:201-213
  • (3-1-23)
  • (3-1-23)

Hospital Pharmacist's Letter. March 2023, No. 390317

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