How to talk about mistakes without ruining your medical interview Part 1

feel defensive about it. That defensiveness will come through in the answer. Hi everyone, welcome back to Alexander Medical Interview podcast. My name is Alexander, I'm a Whopper Train and Medical Interview Coach. Today we're covering one of the most commonly asked and most consistently answered badly questions. I feel like I'm saying that about all of them, but that's what the podcast is. The high yield stuff. Tell me about a time you made a mistake. Tell me about failure. Tell me about something that didn't go the way you planned. Tell me about a time you would do something differently. These are all the same questions just dressed up in different clothes. And most candidates answered in a way that reveals in the middle because they're trying to protect themselves or reveals something that is actually making the talent for all concerns. So by the end of this episode you're gonna understand what channels are actually assessing where they ask this question. The most common ways candidates get it wrong and the foundation of an answer that scores well. Part two, the premium fee going to describe it will go into deeper examinations, work examples, structures and model answers that you've been using as to the best of let's get started. Now why do channels ask this question of what they're actually assessing? Let me start with something that might reframe your entire approach to this question. When a panel answered about a mistake or failure, they already know that you're a doctor or a medical doctor or a human. You've made decisions under pressure with incomplete information while tired. Mistakes are not the exception in medicine. They are a predictable feature of the environment. So the panel is not asking whether you've made a mistake, they know you have. They're asking something more specific and much more important. What happens when you make one? Did you reflect genuinely? Did you take accountability without collapsing into self-blame? Do you learn and change your behaviour? Do you understand the systemic factors that contributed and critically? Do you have enough insight to recognize your own contribution to outcomes without being defensive about it? If that last one was the hardest, well that's the human response to a question about failure is self-protection. We minimize, we contextualize, we subtly shift responsibility or we over-correct and perform things that we don't really feel. Panels can sense both of these things and neither one scores well. What they're looking for maps directly to the CAN meds professional and scholar roles and often communicator and leader roles as well. This question is a CAN meds question in disguise as most of the other interview questions are as well. The professional role do you have insight into your own practice? Can you be accountable without being defensive? Do you understand your obligations when things go wrong? The scholar role? Have you reflected genuinely on this experience? Has it changed how you practice? Can you articulate what you've learned? The communicator role? How do you handle the communication implications of this mistake with the patient, with the team or with your supervisor and the leader role? Do you recognize any systemic factors? Do you do anything to prevent it from happening again? A strong answer to this demonstrates all four of these roles simultaneously and that's why it's worth taking seriously. So why most people/doctors answer this badly? There are five patterns that I see consistently in my coaching sessions when I bring up this question. They all have the same root cause. The candidate is trying to manage the impression they're making rather than genuinely engaging with the question. So pattern one, the non-mistake mistake. The candidate described something that wasn't really a mistake. Oh, I once worked a double shift and felt tired. I made a decision that was correct but in retrospect I should have communicated differently. These are non-ances. The signal to the panel that you are unwilling to be genuinely honest about your fallibility. Which is, in itself, is a red flag because doctors who could not acknowledge a mistake is actually less safe, not more safe. Pattern number two, the blame transfer. A candidate describes a mistake but the story is structured in a way that positions somebody else's the primary cause. The handover was incomplete. The registrar told me to do it. The system failed. These things may all be true and systemic factors are genuinely worth naming. But if systemic factors account for 90% of your answer and your own contribution accounts for 10%. Panels read this as lacking of self-awareness. You need to own your own part even when the system contributed. Pattern three, the excessive apology spiral. The can that it performs profound guilt almost theatrical remorse that doesn't feel authentic. Panels are highly attuned to the difference between genuine accountability and performed accountability. Genuine accountability is measured and specific. It says, "I did this. It had this consequence. I felt this. I learnt this. I changed this. It doesn't need to be dramatic. In fact, the absence of drama is often more convincing." Funny to say that as an actor. Pattern four, the lack of learning. The candidate describes the mistake takes appropriate accountability and then stops. No reflection on what changed. No learning integrated into practice. It was a difficult experience and I'll never forget it. That's not a professional learning statement. That's a closing sentence that tells the panel nothing about whether you're actually a safer clinician as a result. Finally, number five, the missing systemic layer. The candidate describes a personal mistake with no acknowledgement of the broader system that either contributed to it or it could have an effect on. This is the inverse of pattern two. Here, the candidate takes full personal accountability but doesn't name any of the structural factors involved. In medicine, almost every mistake has both a personal and systemic dimension. The complete answer acknowledges both. The systemic layer is what demonstrates leadership thinking and it's what transforms a personal confession into evidence of a doctor who thinks at the level of a safe, reflective system aware practitioner. Wow, I'd like to be that one day. The research on why this matters. Now, I just want to give you some clinical context for why this is such an important professional competency. Not just an interview technique and if you want to use this, go for it if you don't just skip forward. Medical error is a leading cause of patient harm globally. A landmark study published in the BMJ in 2000, the classic to ER is to human, work from the Institute of Medicine, estimated that medical errors cause between 44,000 and 98,000 deaths per year in the United States alone. In Australia, the Australian Commission of Safety and Quality in Healthcare has documented tens of thousands of preventable adverse events annually. The response to those statistics in the research literature has been clear. The biggest driver of error reduction is not individual vigilance. It's psychological safety. This word again, systems where clinicians feel safe to disclose errors, near misses and concerns produce better outcomes than systems where disclosure is punished or stigmatised. AMI Edmondsons research on this is robust and well replicated. What this means is that a doctor who can speak clearly, honestly and proportionately about their own mistakes is not just demonstrating personal virtue. They are demonstrating a professional disposition that the evidence shows is associated with safer healthcare delivery. Panels know this. When they ask about failure, they are in part testing whether you are the kind of doctor who will contribute to a culture of open disclosure and learning or whether you're the kind of doctor who will cover things up or minimise to protect yourself. That framing, failure as a safety culture question, not just a personal reflection question, changes how you approach your question entirely. So the foundation of a strong answer, I'm not going to give you a full structure in the free episode. That's in part two. Go and subscribe to my supercast link. But I want to give you the conceptual foundation that any strong answer needs to have. Number one, choose the right example. The best example is something real, something clinical and resolved. Real, not hypothetical or vague, clinical because this is a clinical interview and resolved, meaning that you have had enough distance from it to reflect on it without still being emotionally activated. If you're choosing an example where you feel defensive about it, that defensiveness will come through in the answer. Choose something that you've genuinely processed. A secondary consideration is the example should be proportionate to your level of seniority. A medical student should not be describing a complex clinical error that requires serious incident review. A specialty training applicant should not be describing something so minor that it seems that they never really made a real mistake. Match the complexity of your example to what a panel would expect at your stage. Foundation number two, lead with specificity, not with hedging. Specificity is the key here with everything with the interview. The structure most candid at default too is long contextual, pre-amble vague description of what happened and a brief statement that it was a learning experience. That structure protects the candidate but provides very little information to the panel. The structure that works well is the opposite. Begin by naming clearly what happened, not in a way that exaggerates the harm, but in a way that doesn't require the panel to read between the lines. I made an error in prescribing that resulted in x. I missed a clinical sign that meant this. I communicated in correct and the patient received this. Specific, clear, and owned. Foundation three. Reflection is not regret. This is the single most important conceptual shift in answering this question well. Panels are not looking for regret. They're looking for reflection. Regret is an emotional state. I feel bad about what happened. Bory. Reflection is a cognitive process. I have analyzed what happened, understood the contributing factors, and changed my practice as a result. One caveat on this is, you still need to include if you had an emotional response in the moment and be vulnerable about that, but not just stopping there. Both are natural responses to making a mistake, but only one is professionally useful, as to some what I just mentioned. Foundation four. The question isn't asking about the worst thing you've ever done. Many candidates end up overcorrecting when I talk about this and choosing an example that is so significant it raises new concerns in the panel's mind. You do not need to describe your most catastrophic clinical moment. You need to describe something that is real enough to be credible, significant enough to be able to generate genuine reflection and resolve enough to demonstrate growth. That middle ground. Meaningful but not catastrophic. This is where the best examples live, and this is why this question is so hard, because if you haven't thought about it and you get it on the day, you are way, way, way more likely to cook it and run that part of your interview. The mistake or failure question is one of the most human questions in the medical interview. Ironically, it is one of the most difficult ones that people find to talk about and directly answer authentically because medicine trains you to get things right. Not to talk about how you got things wrong, but the ability to reflect genuinely on failure is not a weakness. It is one of the defining characteristics of a safe and self-aware clinician and panels at every level understand this. In part two, which is available to premium subscribers, I go through the full answer structure, model answers, the specific language that converts average reflection into high scoring insight and phrases that most often become red flags even when the example is strong. Thank you for listening. I hope you've enjoyed this. If you did, consider subscribing and share this episode with somebody that might find it useful. I'll see you over there.