#30 – This is a perfect, I mean excellent, I mean… gimme another chance … paper

Episode Host:

Jonathan Sherbino

Episode article

McKay, J., Williams, K., & Stewart, J. (2023). You just want a break from the hatred of failure: The lived experience of being a student physiotherapist perfectionist and considerations for educators. Advances in Health Sciences Education. https://doi.org/10.1007/s10459-023-10287-y

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Is perfectionism a tacit prerequisite to excel in health professions training? What does perfectionism do to learners?  And how can educators address the maladaptive behaviours of perfectionists?  Interested?  Then check out this episode. 

Episode notes 


Perfectionism is a narrow road to walk.  Professions and society want attention to detail in healthcare professionals.  The stakes are high in healthcare, so let’s ensure high standards. Yet, the struggle with burnout and attention to wellness is a priority issue for the health sciences.  How to balance? 

Perfectionism is when the attainment of the high standards necessary for the high stakes of healthcare tip.  Perfectionism is defined as an excessive and rigid standard of performance that results in self-criticism and self-doubt.  It is an extreme form of striving that exceeds a normal pursuit of excellence.  It has multidimensions, including self-oriented, socially-prescribed and other-oriented elements. 

If you are a clinician or a HPE scholar/educator (academia can be just as toxic an environment as the clinic or hospital) you have probably experienced the selective pressure that makes perfectionism so persuasive in these contexts.  As Clinician-Educators, we should attend to perfectionism because of the associated maladaptive behaviours that lead to depression, rumination, eating disorders, exercise addiction, suicidal ideation etc. Yeesh….  


[the] literature is limited by its scarceness and tendency to include heterogeneous perfectionist samples, which may mask the true intensity of experience among those with elevated perfectionism. … this study aims to respond to calls for more qualitative work and to address the dearth of research on how highly perfectionistic students experience academic study.” 

The Authors


The authors adopt a social constructive paradigm, using a hermeneutic (interpretation) phenomenology (sensemaking of experience, i.e. what are the participants’ view of the world – as it relates to perfectionism.  There is no perspective here of an external, objective reality.). This methodology incorporates the subjective experience of the researchers as they uncover new meaning in the subjects narratives as a function of their sociocultural context. 

As per a previous episode, a very appropriate and descriptive ethics statement was included. 

This study was conducted a single UK school of physiotherapy students.  

Data was collected over an academic term via log sheets, wehre individuals documented perfectionism experiences.  Post submission, semi-structured interviews were conducted ranging from 60-90 minutes. 

Data analysis was informed by phenomenological and thematic analysis, using an inductive, iterative process. 


Nine woman and 1 man, equally mixed between undergraduate and postgraduate studies with a mean age of 25, participated. 

The composite summary suggested participants were: 

  • High archievers 
  • “all or nothing” 
  • With a need to feel in control. 

Perfectionism was experienced in the physical domain (body image and physical health) and in academic life, leading to fear of failure.  Perfectionism was felt to be a negative phenomenon, rather than a positive motivator.

A white sheet with black text

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Table from the article (McKay et al., 2023)


This study has illuminated a constellation of risks associated with being a perfectionistic student, which are harmful to both the learning experience and health.” 

The Authors

Attention should be paid to: 

  • Support for learners
  • CBT
  • Fostering self-understanding 
  • Introduce adaptive coping patterns 
  • Adapt learning environments 
  • Reduce unnecessarily high expectations 
  • Diminish competitiveness 
  • Emphasize process and effort 
  • Explicitly address perfectionism with learners 
  • Core, induction sessions 


 Shout out to AHSE for not having a word limit in their journal.  This manuscript was 26 pages, allowing substantive quotations and exploration of the 9 themes from this study.  

The authors introduced me to theoretical generalizability (Smith, 2009), where the reader’s professional and experiential knowledge permits association of a study’s findings to contexts that the reader believes relevant


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