Doubt: The spectre at the feast

Dear Sir

I read with fascination the study of Liu et al. (2014), exploring the phenomenon of doubt amongst first year medical students. I have long been interested in the expansive “gap” between the 6th form and matriculation, and its attendant psychosocial repercussions. The authors describe doubt as a highly prevalent entity, which acts “either as a catalyst or mediator of known forms of distress, or as a distinct form of distress”.

Distress must not be ignored in our undergraduates; it may lead to depression and burnout, which can have disastrous consequences for the individual. I remember during my own undergraduate training, occasionally other students would mysteriously disappear, not to be seen again. The whispered rumors were often that they had suffered “a nervous breakdown”; I would suggest that in many cases, doubt and distress had overpowered coping strategies.

Inculcating resilience is becoming a recognized obligation amongst medical educators (Eely & Stallman 2014). We often poorly prepare students for the sometimes overwhelming transition from familial dependence to autonomy, intellectual excellence to intellectual mediocrity, didactic teaching to problem-based learning. We should alert them that many will experience thoughts such as: “I’m not good enough to be here. I am never going to get this. I am a fraud. I have made a terrible mistake”. We should make them aware that there are ways of minimizing doubt – the spectre at the feast – and resilience skills are a crucial part of the doctor’s professional identity. When an individual student recognizes that self-doubt is a universal phenomenon, and not restricted to him or her alone, it becomes a surmountable obstacle. By supporting their peers through crises of confidence, they will in turn be supported, and will be able to nurture the resilience that is prerequisite for a life in medicine.

Declaration of interest: The author reports no conflicts of interest.