Medicine has always attracted perfectionists. The problem is that the kind of perfectionism increasingly common among young adults today may be exactly the kind physicians can least afford.

A new meta-analysis published in Psychological Bulletin found that while perfectionism among college students has risen substantially since the 1980s, the sharpest increases came in what researchers call “perfectionistic concerns”: a fear-driven orientation centered on anxiety about mistakes, failure, and others’ critical judgment.

Researchers say this shift matters for medicine, a field that has long rewarded diligence, precision, and exceptionally high personal standards. But when perfectionism is driven more by fear of failure than by the pursuit of excellence, it may undermine learning, decision-making, and potentially even patient care.

“Anything that requires a lot of diligence and many, many years of intentional application, you’re probably going to find the educational system rewards the perfectionist,” said lead author Thomas Curran, PhD, an expert on perfectionism and associate professor of psychology at The London School of Economics and Political Science in London, England. “Those strivings get you through school, but when concerns start to weigh on your decision-making, perfectionism can turn on its head.”

The findings suggest medicine may increasingly be training a generation of physicians whose perfectionism looks different from that of their predecessors.

“The difference between what young people expect of themselves and what they’re actually able to achieve is getting larger and larger,” Curran said.

“Med students, we might have a great clinic day but make one mistake, and then go home and just focus on that mistake,” said Molly Stegman, an incoming first-year resident at the University of Tennessee in Knoxville, Tennessee. She’s spoken about perfectionism for the American Academy of Family Physicians. “Sometimes it prevents us from reinforcing the good habits we’re learning from the things that we did well because we’re so focused on the one thing we did poorly.”

The culture of medical training may be reinforcing that pattern.

If you’re in a position of leadership, pressure from above probably spurred you to do better in your early days. But that dynamic may not translate the same way for today’s trainees.

“For them, it’s less about excellence than avoiding the consequences of failure,” Curran said.

That distinction matters because medicine depends on trainees being willing to take on new challenges, learn from mistakes, and make decisions in situations where certainty is often impossible. When fear of failure becomes dominant, experts said, it can potentially slow learning and shape clinical behavior in ways that may ultimately affect patient care.

Worrying about failure can also lead to missed opportunities, said Kay Johnson, MD, MPH, a professor of medicine at the University of Washington School of Medicine in Seattle. She’s co-author of a paper on perfectionism in medical training. While some perfectionism may be necessary in medicine, when it goes too far it can become maladaptive. Unrealistic standards, self-criticism, and unwillingness to accept their own best efforts can hold trainees back.

“If you’re afraid of not doing a good enough job, you might procrastinate or avoid taking on new challenges,” she said. That might mean hesitating to reach out to a luminary in the field for mentorship or writing fewer papers, which can affect career advancement.

Here’s how leaders can spot — and guide trainees away from — harmful perfectionism

Perfectionists tend to spend too much time on something that’s important, but not so important it requires hours of attention, Johnson said. If they’re always the last to leave, that’s a red flag.

Another sign: They’re never satisfied with their own performance, so they may come off as being low in confidence. They may have trouble delegating or be slow decision-makers.

The problem isn’t about time management, so suggesting tools won’t help. Instead, help them recognize they may be falling into a perfectionism trap.

“I will say, ‘I’ve noticed some behaviors that remind me of somebody who might be a perfectionist,’ and they usually agree,” Johnson said. Then she’ll ask if their perfectionism gets in the way of their goals — most have never stopped to consider that.

Share how you personally balance good vs perfect and cope with setbacks.

“Students tend to think of us as having all the answers, and there’s something wrong with them if they don’t,” Johnson said. “I once read maladaptive perfectionism described as an occupational hazard of practicing medicine and I agree with this.”

Role modeling, competitiveness, and the pressure to work efficiently — to get things right the first time — all contribute. Guiding trainees to recognize the situation may help ease their anxiety.

If you’re in training or early in your career, here’s how you can avoid falling prey to harmful perfectionism

Divide your work into various buckets. What can simply get done? What can be good but not great? And what has to be of the highest standard? “That gives you permission to take your foot off the gas in certain areas,” Curran said. “You’re not killing yourself over every small task.”

Treat yourself the way you’d treat a friend. “If my close friend messed up on a presentation, I’d say, ‘Oh, that’s normal, everyone makes mistakes, and overall the presentation was great,’” Stegman said. “So what works really well for me is to flip it.”

Seek out the positives. Yes, one thing went wrong. Challenge yourself to identify three things that went right. “It’s not either perfect or a failure,” Stegman said. “It can be a bit of a mix.”

“Medicine is a difficult job, and there will be times when you need some perfectionism,” Curran said. “But you can’t be a perfectionist 24 hours a day. You won’t survive.”

The experts cited in this article reported no relevant disclosures.