A pattern of complaints about an anesthesiology resident’s professionalism comes to the residency program director. When debriefing with the program director, the resident states that he is unaware of the negative perceptions about his behavior. Which of the following terms best describes this self-awareness?
- A) Self-deception
- B) Blind spot
- C) Façade
- D) Arena
B) Blind spot
A behavior or characteristic that is perceived by others but not by the individual is termed a blind spot.
The Johari window technique, created in 1955, can provide a useful framework for thinking about trainee assessment. In this technique, the subjects pick adjectives from a standard list that describe themselves and then their peers pick from the same list to describe the subject. Adjectives are then placed into 4 named quadrants based on whether they were associated with the subject by 1) both peers and subject (arena), 2) only peers (blind spot), 3) only the subject (façade), or 4) neither peers nor subject (unknown).
These quadrants are described as arena (or open), blind spot, façade (or hidden), or unknown.
Image is public domain
Though this exercise does not directly reflect how trainees are assessed in medicine, the four quadrants can be a useful way to reflect on assessments and trainee self-awareness. When assessing trainees, there may be discrepancies between trainee self-perception and that of their peers, mentors, faculty, etc. Of special interest are the façade and blind spot areas. Blind spots represent how the subjects are described by others but may not perceive themselves. Façades are aspects that peers do not recognize in subjects, but subjects identify in themselves. Items in the façade area are self-perceptions that are hidden from others (intentionally or unintentionally) or perhaps a self-perception that does not reflect reality.
When using this construct to reflect on trainee evaluation, faculty should consider whether the trainee has awareness of any detected gaps in knowledge, skills, or behavior. Mentorship and feedback may then focus on ways to bring self-awareness to a trainee’s blind spot or collaborate in improving problem items in the arena (open) area.
- Ghaferi AA, Dimick JB. Understanding Failure to Rescue and Improving Safety Culture. Ann Surg. 2015;261(5):839-840.
Brian F.S. Allen, MD
Director, Acute Pain Service
Director, Regional Anesthesiology and Acute Pain Medicine Fellowship
Department of Anesthesiology
Vanderbilt University Medical Center
Regional anesthesiology fellowship-trained clinician, interested in development and use of educational assessment tools, implementation of enhanced recovery after surgery pathways, opioid minimization, and the use of technology and low-stakes quizzes for resident, fellow, and faculty development.