Beyond Labels: Story and Reflection

It’s not infrequent that I’m in conversation with a faculty member who’s frustrated with one or two residents they see as lazy or disengaged. Those moments take me right back to how I sometimes felt a decade ago, when I was burned out in my core faculty role. I remember the intensity of that frustration, the way it narrowed my view, and how quickly it could sap my energy.

We all know that residents arrive with widely different experiences, strengths, and gaps. Some rotated on a liver transplant team in medical school, most didn’t. Some have lived alongside a sibling with a complex neuromuscular disorder, shaping how they approach every patient, most haven’t. Some are naturally efficient (and occasionally cut corners too soon). Others excel at connection (and can never seem to leave the room).

Some can keep up with the inbox; others are always chasing it. Some welcome direct feedback; others need a gentler nudge. Some get defensive (because they’re humans protecting their ego and reputation). Others are overly self-critical, dismissing even specific praise. Some are driven, some procrastinate, some are burned out, and some are just plain exhausted.

Accepting that allows us to be our best selves in supporting their growth. But when we label someone as lazy, defensive, or disengaged, we risk reacting to the label instead of seeing the person.

If they’re truly under the bar, it becomes a remediation pathway which stretches our growth in a different skillset. If they’re not, we still have a chance to build our nuanced skills as educators. At the end of the day, it is their responsibility to grow into competence, and our responsibility to give them the reasonable and available resources and support they need to get there.

Part of that support is rapport. Connection and trust don’t guarantee success, but they often create the space where honest conversations can happen, where feedback lands, and where a struggling learner is more willing to engage. Sometimes that relationship becomes the turning point.

One approach that can help with our emotional weight is shifting the focus of the thought(s) we are entertaining.

Example: Circumstance: A resident, for the fourth time this week, took the labor and delivery pager before finishing rounds on mother-baby. They have postponed their presentation for the OB team 3 times.  Thought: They are lazy; or They are ignoring me; or They can’t handle this. Feeling: Frustrated. Action: Explain they have to do better, vent to colleagues, don’t explore barriers, start building a narrative of who they really are with various bits of memories that fit.  Result: I’m not acting as the attending I want to be.

Shifted Focus on a Thought we make room for: He’s a tired, busy resident still learning to balance all the things. (Aren’t we all?!) Feeling: Understanding. Action: Explore barriers, troubleshoot together, explain the “why” behind the rule, stay curious, hold the bar. Result: I feel better about how I show up, regardless of his response. (Though of course I’m rooting for him).

Learning medicine is a bit like learning a new language: with vocabulary, grammar, and cultural nuances you can only fully grasp over time. Some pick it up quickly, some get the word for word but miss the subtleties of the sounds; and many need repetition, translation and immersion before they can use it naturally.

When we expect that, we approach each learner with more patience and curiosity, without lowering our expectations for safety and quality. And when someone’s still not following through after you’ve met them where they are, that’s not a personal failure, yours or necessarily theirs. It’s data. You can look at it together: What got in the way? How do we overcome it? What would make it easier next time? Why do they want to do it?

It’s a lot like motivational interviewing with patients. Over time, you’ve learned not to take it personally, or get overly frustrated, when a patient doesn’t follow through on a treatment plan. Instead, you stay curious, explore barriers, and work with them to find a path forward they’re ready for. That same mindset not only helps the learner, it’s how we protect our own energy and experience of the moment.

Reflection question: What changes for us if we expect that some residents will need multiple reminders, in different ways, before a skill or behavior sticks, while we still ensure patient safety and uphold standards?

How do you want to think about your learners?

I'd love to hear what your take is?