Are We Training the Next Generation to Be Incompetent Physicians?

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I remember my clinical training in medical school like it was yesterday. Nearly a decade has passed, but what stands out most are the moments when I was not allowed space to learn.

In the operating room, many surgeons were reluctant to let medical students perform even simple procedures like placing IVs or inserting foley catheters. The reasoning was always the same: “I don’t need a student giving my patient an infection.” On the surface, this makes sense, why take on added liability in a litigious society? Nonetheless the unintended consequence is that we are sending trainees into residency underprepared, hesitant, and lacking the confidence they need to care for patients.

And this issue was not just relegated to surgery. Across clerkships, students were often relegated to note writing, observing, or busywork. Too often, we were learning medicine without doing medicine.

Baptism by Fire

When I entered residency, that dynamic flipped. On my very first inpatient psychiatry rotation, I was paired with a seasoned mentor who struggled with the electronic medical record and the fast pace of a modern service. That left me responsible for an entire caseload almost immediately.

It was overwhelming at first. I felt unprepared and unsure. But I also felt a profound sense of duty—if I did not take ownership, patients could be left behind. Within weeks, my skills improved dramatically. I learned quickly, made mistakes, corrected them, and grew more confident every day. That early immersion taught me something critical: physicians develop best when they are challenged to act, supported by supervision but not shielded from responsibility.

What “Good” Training Looks Like in Psychiatry

In psychiatry, good training does not mean memorizing diagnostic criteria or parroting guidelines. It means sitting across from a patient in crisis and having the courage to lead the conversation. It means developing a treatment plan, even when the path is murky, and then adjusting when the patient responds differently than expected.

I think back to a case early in residency: a young man with new-onset psychosis. I was terrified of “getting it wrong,” but my attending encouraged me to propose and implement a treatment plan. We started aripiprazole, monitored carefully, and built trust with the patient. We were even able to get the patient to agree to a long acting injectable prior to discharge. Within weeks, he was calmer, more engaged, and beginning to recover. That experience of seeing my decision translate into a patient’s healing was far more instructive than any textbook chapter.

This is what good training looks like: opportunities to make real decisions with real patients, always under a safety net but never stripped of responsibility.

The Modern Challenge

Today, I see a concerning trend: even at the resident level, autonomy is being eroded. Too often, residents are told what to order, what to write, and what to do, rather than being given the opportunity to formulate their own plans. In these cases, the resident becomes more of an assistant than a physician-in-training.

Would you trust a doctor who has never truly been allowed to make a decision? I want the next generation of physicians to think critically, analyze information, and take ownership skills that only develop when given room to practice.

A Balanced Approach to Training

In my own teaching, I try to create the environment I wish I had as a student. Residents on my service are encouraged to take ownership of their cases and propose management plans. If their reasoning is evidence-based and thoughtful, even if I would approach it differently, I let them try. If it does not work, we reflect together and adjust course.

I also invite medical students into this process. When they feel their contributions matter, they often notice details the rest of the team missed or provide fresh perspectives that enrich the discussion. These moments are invaluable not only for their learning but for patient care.

At the same time, we should embrace technology not as a replacement for the therapeutic connection that lies at the heart of psychiatry, but as a tool to reduce burnout, improve efficiency, and support better care. The next generation of physicians must be both clinically skilled and technologically adaptable.

Building Confidence as an Early-Career Psychiatrist

For new physicians, the first years out of training are daunting. Confidence does not come overnight, but there are practical steps early-career clinicians can take:

• Take ownership of cases: Don’t just follow orders commit to making your own assessments and plans, even if they are later corrected by a supervisor.
• Seek feedback proactively: Instead of waiting to be told, ask your more seasoned colleagues, “What would you have done differently?”
• Lean into discomfort: Growth often comes from the cases that feel overwhelming at first, pushing just the right amount past your comfort zone is where all the growth can be found.
• Learn from mistakes, not fear them: Safe mistakes under supervision are the most powerful teachers, own them, learn from them, and apply it to your next case.
• Cultivate mentors: Surround yourself with experienced physicians who challenge you but also believe in your potential.

These practices not only build skill but also restore a sense of meaning and purpose in the work.

Moving Forward

We do not serve our patients—or our trainees—by protecting them from responsibility. We serve them by creating safe environments where students and residents can act, reflect, and grow.

To residents: step up. Own your cases, make the tough calls, and learn from your mistakes.
To attendings: step back. Provide the safety net but let your trainees climb.

Medicine is not mastered by watching—it is mastered by doing. If we want competent, confident physicians in the future, we need to train them that way today.

Dr Rossi is an inpatient and consultation liaison psychiatrist who also performs electroconvulsive therapy services at AtlantiCare Regional Medical Center in Pomona, New Jersey. He currently serves on the board of the New Jersey Psychiatric Association, where he has worked on advocacy projects, including enhancing access to collaborative care in the state.