The Kids Are(n’t) Alright: Distinguishing Necessary from Unnecessary Discomfort in Medical Training

Act 1: Rejection of Medicine as a Calling – Trainee Disillusionment

• So what’s let to this rejection of medicine as a calling by more and more trainees in recent years?
• What factors have contributed to this sense of trainee disillusionment?

Covid-19 Pandemic:

• Of course, the COVID-19 pandemic fundamentally altered the training experience. Many trainees described feeling like “just another warm body”, filling shifts when colleagues became ill, often before the risks of COVID-19 were fully understood.
• They also lost much of the sense of community that has traditionally defined residency. Social distancing meant that friendships and support networks were often confined to the hospital, with few opportunities to connect outside of work.
• As one program director reflected: “Although medical training always meant delayed financial gratification, the pandemic amplified the perceived unfairness: if you were barely making rent, saddled with debt, and scrolling through Instagram pictures of friends’ exotic ‘working from home’ destinations while fielding requests to cover shifts for co-residents out with COVID, why wouldn’t you have questioned the fairness of your working conditions?”
• Although the acute phase of the pandemic has passed, many educators feel that this sense of disillusionment has persisted.
  • Those who weathered COVID as senior residents or early staff physicians often encourage a more transactional relationship with medicine among today’s trainees, not out of cynicism, but as a way of protecting them from the sacrifices they themselves experienced.
    • The sentiment can sound something like: “I want to treat medicine like a job, so I need you to treat it like a job too, because it helps validate my own decision to do the same.”
    • Or, put another way: “If I encourage you to leave when your shift is over, it makes it easier for me to leave when mine is over.”

“Anti-Workism” Movement 

• This shift in thinking did not begin with the pandemic. In a widely read 2019 article for The Atlantic, Derek Thompson described the rise of workism, the belief that work should sit at the center of one’s identity, serving not just as a source of income, but of meaning, purpose, and self-worth. He argued that many people had begun rejecting this idea, viewing work less as a calling and more as one component of a well-rounded life.
  • As medical trainees watched these conversations unfold across social media and in popular culture, many naturally began to question whether medicine should occupy such a central place in their own identities.
• Yet the pushback against workism is hardly new.
  • Thompson points to John Maynard Keynes’ 1930 essay, Economic Possibilities for our Grandchildren, in which Keynes predicted that technological progress would reduce the workweek to roughly 15 hours, leaving future generations with the equivalent of a five-day weekend.
  • Even into the 1960s, commentators anticipated that increasing automation and shorter workweeks would lead people to seek meaning not through their careers, but through leisure, relationships, and personal pursuits.
• Those predictions, of course, never materialized. Productivity increased, but so too did expectations of work. Yet the underlying skepticism toward work as the defining feature of one’s identity has endured.
  • Many millennials were encouraged by their Baby Boomer parents to “follow their passion,” only to graduate into unstable job markets carrying substantial educational debt. Instead of finding purpose through meaningful work, many found themselves in jobs that were exhausting, insecure, or disconnected from the ideals they had been promised.
  • For many, this led to an uncomfortable realization: work does not necessarily love you back.
  • It is therefore not surprising that anti-workism gained traction. It is difficult to remain devoted to a “religion” that appears indifferent to your sacrifices.
  • Increasingly, many medical trainees are asking the same question. If medicine does not make them feel valued, included, or supported, why should it define who they are?

Moral Injury

• Another major force driving trainee disillusionment is the growing sense that they are simply unable to care for patients in the way they believe they should. Increasingly, it is not a lack of knowledge or effort that limits good care, but systemic barriers that feel impossible to overcome.
  • One way of coping with this reality is to emotionally distance oneself from work by viewing medicine as “just a job.”
    • The internal dialogue becomes something like: “I can’t afford to become emotionally invested in every patient, because if I do, it hurts too much when the system prevents me from helping them the way I know they deserve.”
• In 2018, Wendy Dean and Simon Talbot introduced the concept of moral injury into the medical literature. Originally used to describe the psychological wounds experienced by soldiers forced to act against their deeply held moral beliefs, the term was adapted to describe what physicians experience when healthcare systems repeatedly prevent them from delivering the care they know their patients need.
  • For many clinicians, this concept finally gave language to an experience they had long struggled to articulate. It shifted the conversation away from burnout, a term that often implies an individual deficiency and invites solutions focused on personal resilience: practice more mindfulness, take more vacations, improve your work-life balance. Moral injury, in contrast, recognizes that many physicians are responding normally to abnormal systems.
  • Yet even physicians who attempt to address these systemic problems through advocacy can feel unsupported by the institutions they serve. 
• Many will remember the case of Kaitlin Stockton, an emergency physician in British Columbia who posted a sign in her emergency department warning patients about prolonged wait times and resource shortages in an effort to be transparent. Rather than being commended for her honesty, she faced threats to her employment and professional standing for speaking publicly about unsafe conditions.
  • Stories like these reinforce the perception that physicians are expected to absorb the consequences of a strained healthcare system while remaining silent about its failures. 
• Taken together, the pandemic, the broader societal rejection of workism, and the rise of moral injury in response to worsening system pressures help explain why many trainees have become skeptical of the idea that medicine is anything more than a job.
  • If medicine is viewed primarily as a job, it naturally follows that there are limits to the discomfort and sacrifice one is willing to tolerate. Protecting one’s own well-being becomes not only understandable, but rational.
  • Increasingly, there is a belief that describing medicine as a calling implies a degree of moral nobility that the healthcare system has failed to earn.
  • The sacrifices that may once have provided physicians with a profound sense of purpose or vocation are, for many, being replaced by the feeling that they are simply another cog in an overburdened machine.

… but is it the chicken, or the egg?

• As this shift has accelerated, some educators have become concerned that the pendulum has swung too far. They worry that viewing medicine exclusively as a job, with no sense of vocation or professional calling, risks sacrificing competence and professional growth in the name of wellness.
• For years, these tensions have existed beneath the surface, discussed quietly in hallways and call rooms but rarely examined openly.
• Yet we cannot meaningfully improve medical training, or fulfill our professional responsibility to patients, without first acknowledging that both perspectives arise from legitimate concerns. Only by understanding why trainees have become disillusioned, and why educators worry about the consequences, can we begin to distinguish the discomforts that are necessary for growth from those that are simply unnecessary burdens.

ACT 2: Tough Love – the Educator’s Perspective

“It’s become almost ‘cool’ to view being a doctor or medical training — and the demands that come with it — as a huge slight and unfair”

“But when every ill feeling is labeled as ‘trauma’, distinguishing among harms of varying magnitudes becomes difficult, as does targeting interventions to root problems”

– Rosenbaum, NEJM Podcast: Not Otherwise Specified, 2024

Trauma as a New Form of Social Capital: “Trauma Creep”

• Some educators have observed a shift in what earns social capital among trainees. Rather than being recognized primarily for qualities such as diligence, resilience, or clinical excellence, there is a growing perception that status is increasingly gained through publicly challenging the norms and conditions of medical training.
• This raises an important question: in trying to correct genuine problems within medical education, are we at times losing sight of the forest for the trees?
• To be clear, this is not because educators oppose trainee wellness. Quite the opposite. Most educators are deeply invested in both developing highly competent physicians and ensuring that trainees remain healthy enough to enjoy long, sustainable careers.
• Where some educators perceive tension is in what has been termed trauma creep. Australian psychologist Nick Haslam has described this phenomenon as the progressive expansion of concepts such as trauma and harm, whereby increasingly less severe experiences come to be interpreted through the same lens as genuinely traumatic events.
• The concern is not that trainees experience distress, many unquestionably do, but that if every uncomfortable experience is framed as harmful or morally injurious, we risk losing the ability to distinguish between the discomfort that is essential for learning and the discomfort that reflects a training system in need of reform.

“Experiencing daily racism, for instance, is different from being asked by your patients if you’re old enough to be a doctor. Having to admit a new patient right before end of shift is not a moral injury, and burnout is not the same as depression.

The substantial proportion of trainees who have debilitating mental illness need adequate care, but we cannot help them — much less address our structural inadequacies — if differentiating between serious illness and the inevitable challenges of training is treated as a moral breach.”

– Rosenbaum, Being Well While Doing Well, NEJM, 2024

• Educators such as Lisa Rosenbaum have posed an important question: in our efforts to minimize trainee discomfort, have we inadvertently compromised the development of the skills required to care for others who are suffering?
• As trainee well-being has rightly become a greater priority, and as concepts such as trauma have expanded, many educators describe an increasing challenge in balancing psychological safety with their responsibility to provide honest, constructive feedback and uphold standards of competence.
• Many also acknowledge that the stakes of giving difficult feedback feel higher than they once did. They worry about being perceived as outdated or insensitive, being accused of learner mistreatment, facing professional repercussions, or simply being viewed as someone who does not care about trainee well-being.
• The result, some argue, is a quieter educational environment, where difficult conversations are avoided, standards become harder to enforce consistently, and opportunities for meaningful growth may be lost.

• To be clear, few would argue for a return to the era of retaliatory teaching, public humiliation, or shaming trainees. Medical education has rightly moved away from these harmful practices.
• Yet many educators worry that, in correcting those excesses, we may be drifting toward the opposite end of the spectrum.
• Some have described this as the “dove phenomenon”: an educational culture that increasingly prioritizes emotional safety over challenge, avoids conflict, hesitates to deliver critical feedback, fears professionalism complaints, and develops a progressively lower tolerance for learner discomfort.
• The concern is not that trainees should suffer unnecessarily, but that growth often requires experiences that are uncomfortable without being harmful. If all discomfort is viewed as something to eliminate, some of the very experiences that foster resilience, clinical judgment, and professional identity may also disappear.
• This distinction extends well beyond medicine. In a conversation with journalist Ezra Klein, adolescent psychologist Lisa Damour observed that our culture has increasingly come to equate being mentally healthy with feeling good, calm, or relaxed. Yet emotional well-being does not mean the absence of difficult emotions. In many circumstances, anxiety, discomfort, grief, and uncertainty are normal and appropriate responses to challenging situations.

• Learning anything, whether it is playing the piano, mastering a new language, or becoming a physician, is inherently uncomfortable. Struggle is not evidence that learning has failed; it is often evidence that learning is taking place. Yet increasingly, this necessary discomfort is at times conflated with threats to wellness.
• As I reflected on these tensions, I found myself drawing an unexpected parallel. Perhaps it is because I am about to become a first-time parent and am already acutely aware of how much I have to learn, but the relationship between trainees and educators increasingly reminds me of that between teenagers and their parents – I suspect most of us can sympathize, at least to some degree, with the parent of a teenager.
  • A parent’s goal is not simply to keep their teenager happy. It is to help them become a capable, independent adult. Those two goals often align, but sometimes they are in conflict.
  • From the parent’s perspective, giving their teenager responsibility, setting boundaries, allowing them to experience failure, and trusting them to navigate uncomfortable situations are all acts of preparation. They are attempts to build the judgment and resilience needed to navigate an unpredictable world.
  • Yet the teenager may experience those very same actions quite differently: as controlling, dismissive, unsupportive, or disconnected from what they believe they need in the moment. 
• Neither perspective is entirely wrong. They are simply rooted in different time horizons. One is focused on immediate well-being; the other is focused on long-term growth. Perhaps the relationship between trainees and educators is more similar than either side would like to admit.

• To be clear, I am not suggesting that trainees are children. Rather, I think there are important parallels in the relationships themselves.
• Like parents, educators are deeply invested in who their trainees ultimately become. Their responsibility extends beyond ensuring that learners are happy today; it is to prepare them to become thoughtful, capable, and compassionate physicians tomorrow.
• This places educators in a difficult position. On one hand, they want to foster psychological safety, support trainee well-being, and avoid unnecessary hardship. On the other, they have a professional obligation to challenge learners, provide honest feedback, and create experiences that develop the competence required for independent practice. Balancing those goals is rarely straightforward.
• As we’ve already discussed, medicine is inherently uncomfortable. It involves physical fatigue, uncertainty, impossible decisions, emotionally charged conversations, and caring for people who are frightened, vulnerable, and sometimes direct that fear toward those trying to help them.
• The challenge, then, is not how to eliminate discomfort, but how to distinguish between the discomfort that is intrinsic to becoming a physician and the discomfort that reflects shortcomings of the training system.
• As the culture of medicine continues to shift, and as trainees become understandably less willing to tolerate unnecessary sacrifice, how should we set expectations around discomfort?
• More importantly, has the pendulum swung so far toward protecting trainee wellness that we have unintentionally deemphasized the pursuit of excellence? Or is that a false dichotomy altogether?

ACT 3: “OK, Boomer” – Kids These Days

• At this point, it would be easy to conclude that today’s trainees are simply less resilient than those who came before them. But after reviewing the literature, I don’t think the evidence supports that conclusion.
  • It is worth remembering that nearly every generation has criticized the one that follows it. Complaints that younger people are less respectful, less hardworking, or less resilient are hardly unique to medicine.
• In fact, writings expressing these sentiments date back as early as 624 BC, illustrating just how enduring this pattern has been throughout history.
  • Experimental psychologist John Protzko and colleagues popularized this phenomenon in 2019, describing it as the “Kids These Days” Fallacy. It refers to the remarkably persistent belief that younger generations are somehow declining, becoming less respectful, less motivated, less intelligent, or less resilient than those before them.
  • What’s striking is that this phenomenon transcends cultures, historical eras, and domains of life. The complaints are remarkably consistent, whether they concern education, manners, work ethic, technology, or medicine itself.
  • Even more remarkable is that these beliefs persist despite evidence to the contrary. Studies have shown that people continue to perceive younger generations as declining, even when presented with data demonstrating that no such decline exists.
  • In other words, before we conclude that today’s trainees are fundamentally different, we should be cautious. History suggests that every generation believes the next one has lost something essential, and history also suggests that they are usually wrong.

There are several well-described psychological mechanisms that help explain why the “Kids These Days” Fallacy is so persistent.

• Memory bias. We tend to remember our own generation more favorably than it actually was, conveniently forgetting the immaturity, poor judgment, and questionable decisions of our youth. In many ways, we project our current selves backward in time, remembering ourselves as more disciplined, responsible, and resilient than we truly were.

• Age-stage confusion. Differences that are really a function of age and life stage are often mistaken for evidence of generational decline. Being inexperienced, emotionally reactive, idealistic, or less comfortable with uncertainty are common features of youth, not necessarily signs that an entire generation has fundamentally different values. Young people often behave much the way young people always have.

• Moral projection. As we age, our priorities and values naturally evolve. Yet we often assume that because we would not behave a certain way today, younger people who do must possess inferior values. This ignores the fact that our own perspectives have changed over time.

• Cultural change. Every generation develops its own language, norms, technologies, and social expectations. These changes can feel unfamiliar or even threatening to older generations because they challenge established cultural norms and reduce the sense of authority that comes with experience. It is easy to mistake difference for deterioration.

• Taken together, these biases remind us that our perceptions of younger generations are not always objective. Before concluding that today’s trainees are uniquely entitled, fragile, or unwilling to tolerate discomfort, we should first consider whether we may be observing a phenomenon that has repeated itself for centuries.

Romanticiziation of the Past

• In many ways, we have a tendency to romanticize the past. We remember not only our own experiences more fondly than they were, but often an entire era as somehow better than the present.
  • Interestingly, this tendency appears to be strongest in the domains in which we ourselves excel. Someone who loves reading may be convinced that “everyone used to read more.” Someone passionate about music may insist that music “used to be better.” We often mistake our own experiences and interests for those of an entire generation.
  • Medicine is no exception. Many of us cling to the belief that the way we trained produced better physicians, often without recognizing how much nostalgia and cognitive bias may be shaping that conclusion.
• More importantly, there are compelling reasons why we should not simply preserve the training model we inherited.

• Modern medical residency is often traced back to William Stewart Halsted at Johns Hopkins Hospital, whose training model fundamentally shaped postgraduate medical education.
  • Halsted developed much of this system while struggling with cocaine addiction, later compounded by morphine dependence after attempts to treat his addiction.
  • His philosophy demanded total commitment to the hospital. Residents quite literally resided in the hospital, working extraordinary hours with little opportunity for sleep, family life, or personal identity outside of medicine.
• Thankfully, residency has evolved substantially since then. Residents no longer live in the hospital, duty hour restrictions exist in many jurisdictions, and post-call recovery has become an accepted part of training.
  • Yet it is worth pausing to reflect on the origins of the system we inherited. The fact that our training model still bears recognizable features of one that was conceived under conditions so extreme that its architect required powerful stimulants simply to sustain it should give us reason to continually question whether tradition alone is sufficient justification for preserving it.

• There is little debate that meaningful problems exist within our current training environments, and the data support this.
  • According to the 2025 Canadian Medical Association National Physician Health Survey, 58% of Canadian residents and fellows screened positive for depression on the PHQ-9.
  • Other studies have shown that medical students begin training with mental health comparable to that of their non-medical peers. Yet within the first weeks of medical school, even before clinical rotations or meaningful patient contact, measures of depression, anxiety, and psychological distress begin to diverge. In other words, the deterioration in well-being starts long before trainees are exposed to many of the clinical stressors we often assume are responsible.
• Taken together, these findings make one thing abundantly clear: many aspects of medical training genuinely do need to change.
• Up to this point, however, much of this discussion has been framed as though wellness and competence exist in opposition, as though every gain in one must inevitably come at the expense of the other.

• Increasingly, medical educators are challenging that assumption. Rather than viewing wellness and excellence as competing priorities, an emerging body of work suggests this may be a false dichotomy altogether.

• Do and colleagues argue that physician well-being and competence are not competing goals, but mutually reinforcing ones.
  • They contend that there is little evidence to support the long-held belief that suffering, exhaustion, or self-sacrifice are necessary ingredients for producing excellent physicians. Instead, they suggest this perceived trade-off reflects a historical culture within medicine that equated toughness with competence and endurance with professionalism.
• In contrast, the contemporary evidence overwhelmingly supports the opposite conclusion: improving trainee and physician well-being improves competence.
  • This relationship has been demonstrated across a wide range of outcomes, including improved patient outcomes, higher-quality care, better clinical performance, greater empathy, stronger communication skills, and more resilient healthcare systems.
  • Even relatively simple educational interventions support this principle. For example, pass/fail grading has consistently been associated with improvements in student well-being without compromising academic performance.
  • Conversely, excessive work hours, sleep deprivation, psychological distress, and fatigue are all associated with increased rates of medical error and poorer clinical performance.
• Taken together, the evidence is remarkably consistent: prioritizing well-being enhances, rather than detracts from, physician competence.
• The benefits extend well beyond the individual learner. Physicians and trainees who feel supported and valued are more likely to remain in the profession, engage meaningfully in their work, and contribute positively to their teams.
  • These effects ripple outward, improving retention, reducing turnover, strengthening workforce stability, increasing organizational efficiency, and ultimately enhancing continuity of patient care.
  • For these reasons, Do and colleagues argue that supporting physician well-being is not simply a moral obligation. It is also a strategic investment in the future of the healthcare system.

• A forthcoming paper by Ottawa’s own Dr. Ahn introduces the concept of desirable difficulty, offering a framework for reconciling wellness and competence.
• The premise is simple: an educator’s role is not to eliminate difficulty in pursuit of comfort or likability, but to intentionally create learning experiences at the optimal challenge point; difficult enough to promote growth, but not so overwhelming that they lead to frustration or disengagement.
• Ahn and colleagues argue that psychological safety and desirable difficulty are complementary, not competing, conditions. Challenge without support can feel threatening, while support without challenge limits learning.
• The goal, therefore, is not to eliminate discomfort, but to distinguish between the discomfort that helps trainees grow and the discomfort that serves no educational purpose.

Zone of Proximal Development

• Dr. Ahn also highlights the importance of teaching within the Zone of Proximal Development (ZPD), the range of tasks a trainee cannot yet perform independently but can accomplish with guidance from a more experienced physician.
  • This is the space just beyond a learner’s comfort zone, where challenge is balanced with support and meaningful learning occurs.
  • A classic example is a junior resident managing overnight consults with ready access to a senior resident or fellow. The challenge promotes growth, while the supervision provides psychological safety.
  • That same situation, however, becomes unnecessary discomfort when appropriate supervision is unavailable, leaving a junior learner to manage critically ill patients beyond their level of training alone.

Act 4: Lights, Camera, ACTION! Where do we go from here?

• If wellness and competence are not competing goals, then the question becomes: what practical steps can trainees, educators, and healthcare systems take to create learning environments that promote both?
  • Rebuilding trust will require humility, connection, and a shared commitment from everyone involved. As Dr. Ahn writes:
    

“Learning is not a solo endeavor, care is not delivered in isolation, and professional identity is shaped in and through relationships with others.” Improving medical education will require a collective, rather than an individual, approach.

For Trainees

• Just as good parents allow their children to struggle at a level that is developmentally appropriate, good educators do the same for their learners. The goal is not to make training comfortable, but to provide the right amount of challenge with the right amount of support.
  
  • It is also important to recognize that many of the cultural shifts occurring in medical education are not unique to medicine. Similar changes are occurring throughout education and parenting, reflecting broader changes in how society thinks about learning, motivation, and personal growth.
    • For example, educational philosophy has shifted away from simple praise such as “Great job” or “I’m proud of you.” Instead, there is greater emphasis on continuous improvement and intrinsic motivation, asking questions like, “What will you do next?” or “Are you proud of what you’ve accomplished?”
    • Decades of educational research suggest that intrinsic motivation is a far more powerful driver of deep learning, resilience, and long-term performance than external validation alone.

• A useful framework from vocational psychology is Self-Determination Theory, which proposes that three psychological needs underpin motivation and well-being:
  • Competence: “I can do this, and I’m getting better.”
  • Autonomy: “I choose to do this.”
  • Relatedness: “I feel supported and connected.”
• Educational approaches that foster intrinsic motivation strengthen all three of these domains, promoting both well-being and deeper learning.

For Educators

• We often describe the educator-learner relationship as that of a coach and an athlete. The challenge in emergency medicine, however, is that we may only have a single shift to establish trust before asking learners to step into their Zone of Proximal Development and experience desirable difficulty.
  • That makes it especially important to be explicit about why we challenge trainees.

• Dr. Jim Yang recommends setting expectations at the beginning of the shift, echoing advice he learned from Dr. Jason Frank during residency. He tells learners:

“My job as your teacher is to identify and fill gaps in your knowledge. To do that, I’m going to ask questions and challenge your thinking. I’m doing this to help you learn, not to make you feel bad for not knowing something. If I don’t challenge you, I haven’t done my job as an educator.”

• Dr. Doran Drew offers a similar approach to feedback, building on advice from Dr. Eric Clark. Rather than labeling the learner, he makes feedback action-oriented and forward-looking. A simple framework is: “To take things to the next level, next time I’d like you to…”
• When more difficult feedback is required, Dr. Drew recommends focusing on behaviours rather than the individual. For example:

“I’d like to talk about that case. I’m concerned that, if I hadn’t been there, the patient’s care may have been unsafe. I suspect there’s a knowledge gap here, which surprised me. Can you walk me through your thinking?”

• Small changes in language like these help communicate that challenge and support are not competing priorities. They reinforce that asking difficult questions and providing honest feedback are acts of investment in a trainee’s growth, not judgments of their worth.

For Medical Schools, Residency Programs, and Healthcare Systems

• The responsibility for creating healthy learning environments does not rest solely with trainees and educators. The institutions that shape medical education also play a critical role.
  • As we’ve explored throughout this discussion, opinions differ on whether our current systems overemphasize wellness or fail to support it adequately. The reality is that most institutions are trying to balance two equally important responsibilities: supporting trainees while maintaining the standards required to produce excellent physicians.
• The challenge, then, is not choosing between wellness and competence, but designing systems that intentionally promote both.
  • One issue that illustrates this tension particularly well is the increasingly debated question of when it is appropriate for trainees to call in sick to work.

• A 2025 study from Ottawa led by Lorenzo Madrazo examined illness presenteeism, the tendency for physicians and trainees to come to work despite being physically or psychologically unwell because of professional, cultural, or systemic pressures.
  • The findings were striking: between 80% and 90% of physicians and trainees reported working while sick, with little evidence that this behavior has meaningfully declined since the pandemic.
  • Illness presenteeism is associated with important downstream consequences, including poorer physician mental health, an increased likelihood of future prolonged sick leave, and higher rates of medical error.
• In other words, there is clear evidence that many physicians still come to work when they should not.
  • At the same time, anecdotally, many educators perceive the opposite problem: that sick calls have become more common since the pandemic, with some questioning whether “sick days” are always being used for illness.
  • Neither extreme serves medicine well. Working while genuinely ill is harmful to physicians, patients, and healthcare systems. Equally, unnecessary absenteeism places additional strain on colleagues and the healthcare system.
    • Perhaps these observations are not as contradictory as they first appear. It may be that some of the perceived increase in sick calls simply reflects physicians feeling more comfortable staying home when they are legitimately unwell, a cultural shift that is both expected and appropriate after the pandemic.

Expert Opinion: Dr. Melanie Lewis

• Author of the recent false dichotomy publication, a practicing pediatrician and Chief Wellness Officer at the University of Alberta reflects that:

“Since Covid I think folks realize that is ok and professional NOT to come to work sick. I think more sick calls demonstrates we are starting to interrogate our “superhero/super human” constructs.

During the pandemic, we were told NOT to come to work with Covid, that it was irresponsible, unprofessional and dangerous to patients.

We developed back up call schedules, redundancy on in-patient and ED teams, and this is one of the positive legacy pieces coming out of Covid”

• One possible explanation comes from a common principle in organizational psychology: in most organizations, the vast majority of people want to do good work, act professionally, and follow established norms, while a much smaller minority will consistently test the boundaries of any system.
• The implication is an important one. Institutions should design policies for the majority, not the outliers.
  • Most trainees come to work because they genuinely want to learn, be challenged, and provide excellent patient care. They should not be subjected to policies built around the small minority who may misuse the system.
  • At the same time, programs must recognize that every system will occasionally be exploited. The solution is not to respond with blanket restrictions, but to identify and address outliers individually while preserving a culture of trust for everyone else.

Summary

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