Room for improvement: Palliating the ego in feedback-resistant medical students.

Feedback in medical education provides the impetus for growth in a field pressured to demonstrate continuous progress. Unfortunately, as it always incorporates some level of judgment, certain students appear more resistant than receptive to receiving feedback. Coupled with the ubiquitous stressors of medicine-examinations, perpetual knowledge acquisition, competition for employment-there subtly emerges a learning environment in which the mindset of medical trainees morphs from collegiality to outperformance of one's peers. As the unconscious mind is ultimately focused on self-protection, the cognitive response of reflecting upon received feedback is overcome by an emotional response to safeguard one's self-image against criticism in a culture of comparison. Although self-confidence plays a critical role in mitigating burnout, the relationship between resiliency and ego-armoring is rarely discussed in the literature. Consequently, despite the best intentions of educators in fostering clinical maturity among their trainees, the fact remains that insecurity, inadequacy and invulnerability continue to drive feedback-resistance among medical students.