Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Flipping the Switch


Shifting away from needing external validation can promote wellness. Self-reflection and awareness of our internal monologue may help with internal validation and improve feelings of self-worth.

“I am not what I think I am, and I am not what you think I am. I am what I think you think I am.”

– Charles Horton Cooley


Those of us in medicine got here because we always strove to do our very best and to be at the top of our class. From a young age, we looked forward to straight A’s on report cards, good board exam scores, letters of recommendations, and positive performance evaluations. External validation from superiors has often been the compass that determines whether we’re headed in the right direction.


I remember feeling proud after reading several positive comments in a residency evaluation. However, I also recall a time when I received constructive criticism from a mentor that led to self-flagellation and self-doubt. External validation can be incredibly damaging. Chasing validation from others can lead down the slippery slope of people-pleasing at the expense of suppressing your own interests, opinions, and ideas. Dependency on others’ approval to provide a sense of self-worth and identity can also be crippling when you receive negative feedback.


The antidote to our addiction to external validation is to foster more internal validation. There comes a time after medical training where you’ll need to provide encouragement for yourself, as you may not have mentors to do it for you. Developing the ability to provide self-validation is a good habit to get into early on, in order to nurture more self-confidence and self-worth throughout your career.


How can we grow out of our ingrained habits and learn to rely more on internal validation to bolster our own self-confidence while still maintaining balance? After all, a complete refusal to listen to others’ concerns or feedback is also counterproductive and damaging. The key to balance is fostering awareness and self-reflection.


Internal validation and reflection can be incredibly useful tools when it comes to providing better care for your patients. Having the ability to take constructive feedback, reflect, and apply it helps to improve patient care further. Being able to recognize your strengths and successes also lets you know what’s working for your patients now and what to continue. Without either of these, you risk complacency or insecurity, both of which can certainly hurt your patients, in addition to hurting your own personal and professional growth!


1. Awareness and non-judgement

We all have an internal voice that is often very critical. Try to observe what this voice says to you and how it makes you feel without judgment. This can determine whether any negative thoughts/feelings you are experiencing are due to an actual mistake and whether the amount of criticism is proportionate to the incident. Taking this more balanced approach can prevent you from the extremes of completely beating yourself down or ignoring feedback altogether.


2. Compare apples to apples

Instead of comparing your own progress to others’ as a yardstick of success, a healthy dose of self-reflection to think about how far you’ve come can be useful. This can help to put your failures in perspective and be a great starting point if you truly do feel that you’re not living up to your potential. Keeping a running list of your accomplishments is a great source of tangible evidence to help with this.


3. Give yourself a pat on the back

Awareness of your internal monologue can help to improve self-worth and your relationship with yourself. The next time you make a mistake, try saying to yourself, “I did the best I could with what I knew at the time.” Similarly, when you do something great, even if it’s not acknowledged by others, go ahead and be proud of yourself! There’s no shame in telling yourself, “I did a great job taking care of that child with asthma today.”