This is Part 1 of a two-part series exploring how the feedback you receive shapes your emotional experience and resilience in healthcare training.
Your attending physician watches you complete a thorough history and physical examination. At the end, she smiles warmly and says, “Excellent work! You’re a natural at this.”
You feel great. Validated. Confident. Maybe even a little proud.
Three days later, you’re struggling with a complex patient presentation. Your differential diagnosis feels scattered. You stumble through the case presentation. That same attending looks concerned: “Hmm, that’s not quite what I expected from you.”
Suddenly, the earlier confidence evaporates. You feel anxious. You question whether you actually belong in healthcare. That praise that felt so good now feels like pressure, like you’ve been exposed as a fraud who just got lucky the first time.
I lived this exact cycle during my clinical year. My preceptor kept telling me I was “gifted” at patient communication. It felt amazing until the day I had a complex patient interaction that didn’t go well. Suddenly, that label felt like a lie. If I were “gifted,” why did I struggle? Maybe I wasn’t actually good at this. Perhaps I’d been fooling everyone, including myself.
What I didn’t understand then, but desperately wish someone had explained, was that the type of praise I received was actually undermining my resilience. The feedback that initially felt so good in the moment created fragile confidence that crumbled under pressure.
There’s fascinating research about why this happens. Understanding it changed how I experience feedback, how I give feedback to students, and ultimately, how I maintain positivity through the inevitable ups and downs of clinical practice.
The Two Types of Praise
Carol Dweck’s research reveals that not all positive feedback is created equal. There are two fundamentally different types of praise, and they produce completely different emotional and performance outcomes.
Person Praise focuses on traits or abilities:
- “You’re so smart.”
- “You’re a natural at this.”
- “You’re really talented.”
- “You’re brilliant.”
Process Praise focuses on effort, strategies, and behaviors:
- “Your systematic approach to that differential was thorough.”
- “You prepared really well for that presentation.”
- “I noticed you used several effective questioning techniques.”
- “The way you explained that to the patient showed careful thought.”
These are subtle differences. The emotional and performance consequences are profound.
The Puzzle Study That Revealed Everything
In a landmark study, Dweck and her colleagues gave students challenging puzzles to complete. After successfully solving the first puzzle, students received either person praise (“You must be smart at this”) or process praise (“You must have worked really hard”).
Then came the crucial choice: students could choose either an easy puzzle or a more complex one.
The results were striking. Students who received person praise overwhelmingly chose the easy puzzle. Students who received process praise were more likely to embrace the challenging puzzle.
Why? Because person praise had communicated something dangerous: “Your performance reflects your fixed ability. Don’t risk revealing that maybe you’re not actually that smart.”
The experiment continued. Both groups then tackled difficult problems designed to be frustrating. When they returned to easier puzzles afterward (similar to those they’d previously mastered), the person-praised students showed dramatically reduced performance, even on problems they’d already solved. The process-praised students maintained or improved their performance.
Perhaps most remarkably, when allowed to report their scores, the person-praised students were significantly more likely to lie about their performance.
Let that sink in. Well-intentioned, positive feedback (“You’re so smart!”) can lead to worse performance, reduced persistence, and compromised integrity.
And here’s the neuroscience behind it: person praise creates confidence that depends entirely on continued success. When struggle arrives, the brain interprets it not as normal difficulty but as evidence that you lack the praised ability. Your motivation and sense of competence plummet. Process praise, by contrast, maintains intrinsic motivation and feelings of competence even after failure because struggle is just information about what strategies to try next.
How This Plays Out in Healthcare Training
I witnessed this pattern unfold vividly during my first year of supervising PA students in dermatology.
Two students rotated through my clinic within weeks of each other. Both were bright, motivated, and genuinely interested in dermatology. However, they received wildly different feedback from their previous preceptors, and I observed that these differing feedback patterns led to dramatically different responses to challenges.
Alex: The “Natural”
The first student, Alex, arrived with a reputation. “Wait until you meet Alex,” the program director told me. “Absolutely gifted with visual diagnosis. Just has a natural eye for skin lesions.”
When Alex correctly identified a classic case of pityriasis rosea in the first week, I found myself echoing that sentiment: “You’re really talented at this. You’ve got the eye.”
Jamie: The Systematic Learner
The second student, Jamie, had no particular reputation. During Jamie’s first accurate diagnosis (also pityriasis rosea), I happened to be more specific: “I noticed you looked at the distribution pattern first, then examined the herald patch closely before checking the rest of the body. That systematic approach led you to the right diagnosis.”
The Divergence
Three weeks in, both students encountered an elderly patient with multiple ambiguous skin lesions. Some looked potentially concerning. Others were clearly benign. But several fell in that uncertain middle ground where clinical judgment and careful reasoning matter most.
This is where their paths diverged sharply.
Alex seemed paralyzed. When I asked, “What’s your assessment of the lesion on the left forearm?” Alex’s confidence evaporated. “I’m not sure. Maybe it’s just a seborrheic keratosis? Or could it be something else?” Every question I asked was met with visible anxiety. Alex stopped volunteering to examine concerning lesions. During our daily case reviews, Alex stayed quiet unless directly called upon.
The confident student who had “the eye” in week one had disappeared.
Jamie, facing the same diagnostic uncertainty, responded in a completely different way. “This one is tricky. The borders are irregular, but the color is fairly uniform. Can we dermoscope it together and talk through what we’re seeing?”
Jamie actively sought out the ambiguous cases. “I want more practice with the lesions I can’t immediately categorize,” Jamie told me. The confidence grew week by week, built on accumulated pattern recognition and systematic examination skills rather than on a label about having “the eye.”
Same clinic. Same preceptor. Same types of challenging lesions. But the feedback they’d internalized created entirely different responses to the inevitable diagnostic uncertainty that defines dermatology.
I realized I’d accidentally set Alex up for that anxiety by reinforcing the “natural eye” narrative. And I’d accidentally supported Jamie’s resilience by describing specific examination approaches rather than making judgments about inherent visual talent.
That was the moment I started paying attention to every single piece of feedback I gave.
Why Person Praise Sabotages Your Resilience
Here’s what the research reveals about why person praise, despite feeling good in the moment, actually undermines the resilience you need for healthcare training:
It Creates Praise Addiction and Steals Intrinsic Joy
Researcher Alfie Kohn describes how constant person praise creates what he calls “praise junkies.” Instead of developing internal judgment and satisfaction, people become dependent on external validation. They work not for the inherent value of learning but to get the next hit of approval.
In healthcare training, this manifests as students who perform for attendings rather than focusing on patient care. They experience crushing anxiety when they don’t immediately excel. They avoid asking questions that might reveal knowledge gaps. They prioritize looking competent over becoming competent.
Person praise also transforms activities from something intrinsically interesting into performances that will be judged. Think about a student who receives repeated praise for being a “natural diagnostician.” Over time, each patient encounter becomes less about the fascinating puzzle of diagnosis and more about maintaining that identity. The joy gets replaced by pressure.
It Breeds Fixed Mindset
Person praise explicitly communicates: “You have this quality. It’s part of who you are.” This suggests abilities are fixed traits rather than skills that develop through practice.
When difficulty inevitably arrives (and in healthcare, it always does), the person-praised student interprets struggle as evidence they don’t actually have the trait after all. The positivity built on person praise collapses precisely when it’s needed most—during challenges.
Research by Wood and Bandura with business students demonstrates the real-world impact: students who were told a management task measured their “basic, underlying capabilities” (fixed mindset framing) were significantly less likely to identify mistakes, use feedback to improve, or maintain healthy confidence compared to students who were told their skills would develop through practice. As time passed, the effort of the fixed mindset group decreased, while the effort of the growth mindset group increased.
This is what happens in clinical training when feedback focuses on traits rather than process.
It Reduces Risk-Taking
Studies show that students praised for ability are less likely to take intellectual risks and more likely to give up when faced with difficulty. They’ve learned that struggle means lack of ability, so they avoid situations where they might struggle.
In clinical training, this creates practitioners who:
- Avoid complex cases
- Don’t stretch into uncomfortable learning experiences.
- Become defensive rather than curious when challenged
- Stop developing once they reach “good enough”
What Nobody Tells You About Healthcare Culture
Here’s the irony: healthcare gives extensive critical feedback (sometimes too harshly), but when we do provide positive feedback, we often default to person praise: “You’re a great clinician.” “You’re really smart.” “You’re a natural with patients.” “You’ve got the gift.”
These statements feel good to give and receive. But they create the fragile positivity that collapses under the inevitable pressures of healthcare training and practice.
During my training, I craved this type of praise. I thought it meant I was succeeding. What I didn’t realize was that it was actually making me more vulnerable to self-doubt, more dependent on external validation, and less resilient when challenges came.
The praise that feels best in the moment often serves us least in the long run.
Understanding Is The Foundation
Now you understand why person praise, despite feeling good, actually undermines the resilience and sustained positivity you need for healthcare training.
You see how it creates confidence that depends on continued success rather than on the capacity to learn and improve. You understand why students praised as “naturals” often struggle more than students recognized for their effort and strategies. You know what’s happening in your brain when that early praise transforms into later pressure.
But here’s the challenge: understanding this intellectually doesn’t automatically change how you give or receive feedback.
What Comes Next
In Part 2, I’m going to share practical tools for both giving and receiving process praise. You’ll learn:
- Specific language to use when giving feedback
- How to redirect person praise when you receive it
- How to create feedback environments that actually build resilience
- What to do when you’re stuck with a preceptor who only gives person praise
Because here’s what I’ve learned: you can’t always control what feedback you receive. However, you can learn to recognize which feedback supports your growth and which undermines fragile confidence. You can learn to give feedback that genuinely helps others. You can also learn to seek out and internalize the type of feedback that fosters sustainable positivity and resilience.
Read Part 2: “How to Give (and Get) Feedback That Actually Builds Resilience”
Until then: Pay attention to the feedback you give and receive. Notice whether it focuses on traits or process. Notice how different types of feedback affect you, not just in the moment, but over time.
Just noticing is the first step.
