Wellbeing vs competency? Debunking the false dichotomy in medical education

Numerous studies have shown that medical learners experience poorer wellbeing than their counterparts in the general population. Over the last decade, medical learner wellbeing has become front-of-mind for educators and administrators, which has helped drive systematic improvements in learning and working environments. However, as awareness has grown on the importance of learner wellbeing, a parallel narrative has emerged that questions whether these initiatives are impacting the development of medical competency. In this article, the authors argue that the false dichotomy of wellbeing vs competency stems from a historical medical culture that prized self-sacrifice and "toughness" as markers of competence. There is no doubt that professional growth in medicine requires elements of discomfort and uncertainty. However, the line between productive stress and harm has historically been blurred and pushed by medical training. This culture of "toughness" consequently reinforces a harmful hidden curriculum that dissuades learners from raising appropriate concerns about excessive workloads and mistreatment. However, the evidence is clear that enhanced learner wellbeing promotes competency and patient safety, rather than detracts from it. The authors, therefore, propose a set of actionable steps to support both the personal health and professional development of learners. This includes distinguishing between necessary and unnecessary discomfort, integrating wellbeing into continuous quality improvement, fostering open and safe dialogue between learners and faculty, as well as committing to a cultural shift in medical education that embeds wellbeing into structural systems and policies. Through recognizing wellbeing as an integral part of competency, learners can be supported to become highly skilled, resilient, and compassionate members of the health workforce.