The heart rate started to fall, and so did my confidence.
It was a routine laparoscopic cholecystectomy. After insufflation, I watched the monitor as the patient’s heart rate drifted downward. Not catastrophically, but enough to make me pause. I adjusted the anesthetic, gave medication, and waited while second-guessing every decision.
My attending walked into the room, intervened calmly, and the patient stabilized quickly. The case moved on, but I didn’t. Afterward, the feedback was measured and appropriate. But that is not what I heard. What I heard was: “You should have known what to do.”
There was a time during residency when I was certain I didn’t belong. Anesthesia felt less like a skill I was developing and more like a test I was constantly failing. Looking back, what stayed with me was not the bradycardia or the management choices. It was the meaning I assigned to each moment.
Now, as an associate program director, I see that feedback is never received in a vacuum. It is filtered through identity, prior experiences, confidence, and a trainee’s underlying sense of belonging. And the same words do not land the same way for everyone.
In my experience, female residents often interpret feedback differently than their male peers. A comment meant as technical coaching may be internalized as a broader statement about competence. A routine correction may reinforce an existing fear that they are not measuring up. A momentary hesitation may feel less like a learning opportunity and more like exposure.
Of course, many male residents are also deeply self-critical, and certainly there are female residents who are highly confident. There are no absolutes, but patterns matter.
Female trainees are often navigating an additional layer of pressure: the sense that confidence must be repeatedly earned, while mistakes may feel more visible and more defining. In procedural fields especially, where decisiveness and authority are highly valued, women may feel they must perform competence before they are granted the assumption of it.
So, when an attending says, “You need to be faster,” one resident may hear, “Speed comes with experience.”
Another may hear, “You are falling behind.”
When an attending steps in during a difficult airway or an unstable moment, one resident may hear, “This is teaching.”
Another may hear, “You could not handle this.”
That distinction matters. Residents do not just remember the feedback itself; they remember what they believed it said about them. At this key point in their career, it can leave a lasting mark on how they view themselves as a physician. This is especially significant for female residents who may struggle with impostor syndrome during their careers.
The female residents who replay cases, ask more questions, and seek reassurance are often not the weakest trainees in the room. Frequently, they are among the most conscientious. They are thinking deeply, preparing carefully, and holding themselves to high standards. Yet they may also be the most likely to mistake conscientiousness for inadequacy.
As faculty, we say we value growth, but we often reward visible confidence. We praise decisiveness while overlooking reflection. We tell residents they are progressing, but we are not clear enough for them to believe it. That gap has consequences.
Some residents leave feedback sessions motivated. Others leave questioning whether they belong.
Small changes can make a difference. Explicitly separating the person from the performance. Naming progress out loud. Framing corrections within the normal arc of training. Recognizing that reassurance is sometimes as educational as critique.
The goal is not softer feedback; it’s smarter feedback — feedback delivered with the understanding that identical words can create very different outcomes, depending on who hears them.
If I could speak to my former self, I would not tell her to struggle less. I would tell her not to confuse discomfort with deficiency. To learn, you must be placed in clinical situations that push you out of your comfort zone. This uncertainty is not a sign of inadequacy. Often, it is a sign of insight.
And many of the residents who feel it most acutely are not falling behind — they are paying the closest attention.
What was the most effective feedback you received as a resident and how did it help build confidence and knowledge? Share below!
Dr. DeAnna Pollock is an anesthesiologist and associate program director at St. Joseph’s Medical Center in Stockton, CA highlighting the struggles of medical training and the importance of trust and communication in medicine.
Illustration by Jennifer Bogartz
