by Sneha Kannan
Sneha is a 2nd year medical student at the University of Pennsylvania. She currently writes for Making the Rounds, a blog from the Perelman School of Medicine at the University of Pennsylvania.
Sneha traveling in Rome Success is a funny thing to us medical students. We’re trained to always think about The Next Step and how we get there. One can hear us routinely speak about 2019 as if it’s tomorrow. Until now, in our second year, at the end of our classes and right before we start rotations, “success” in achieving those goals was clear to me. I knew what I had to do to get where I wanted to go. There was a certain cut-off for my GPA to get into my dream college and for my MCAT to get into my dream medical school. I had to show leadership by being the President of some club and show initiative by shadowing doctors and volunteering in the community. This isn’t to trivialize my or my colleagues’ résumés, but simply to make the point that determinants of success were clear until now. The idealist could argue that this view is cynical. After all, if you just do the things you want in life, success should come. To an extent, that’s true in medicine. But there are certain things that everyone has to do to move on to the next step. Now, it’s just harder to know what those are. We don’t really have a GPA anymore. And our clinical grades do matter, but it’s unclear how much. Subjective recommendations become as important as objective numbers. But much more immediate than that, how would I gauge if I know medicine? Is it a good Step 1 Board score? Is it good clinical grades? Stellar preclinical grades? Meaningful interactions with patients? The determinants of success have become murky. But personally I went through a larger change. In the past few months, towards the end of my first year in medical school, I had a fundamental shift in what I inherently call success.
The academic realm
In college, I focused on understanding the principles and concepts taught in class. Our exams were so hard that I was proud of myself if I did well because I knew I really got it. Now, tests cover a fraction of the material we learn in a given month. And the information we learn in our preclinical curriculum doesn’t translate directly to the care of patients. The number of times we hear, “the boards love this, but I’ve yet to see this disease in my career,” is comical. So it behooves me to stop caring about my absolute score on exams and start developing an internal barometer for my understanding of basic principles in medicine. I’ve started to assess my knowledge less on retention of facts and more on an ability to systematically apply a method of analyzing medical problems. (This likely comes from the engineer in me). We and most other medical schools have a class called Differential Diagnosis, where in response to a patient’s history and physical exam we have to come up with a list of diagnoses that are most likely and prove our recommendations (perhaps the closest to ‘House, M.D.’ we ever get). This class phenomenally captures the method of thinking I mentioned previously. Finding facts is a job for UpToDate and Google, but our job is to know how to look for the right things. Going methodically by organ system and having a basic global understanding of physiology is a good start – the rest can be found on the Internet. Unsurprisingly, it’s been one of my favorite classes to date.
The social realm
College was the first time I really had to juggle my academic life, my friends, and personal responsibilities like sleep. More meaningfully, it marked the dawn of my frankly alarming dependence on Google Calendar. There was a certain self-importance that came with seeing how busy I could be and how many demands I had on my time. Especially at MIT, there was a social currency in the number of back-to-back meetings or colors on an iCal. Success was defined as the ability to fit everything in my life. But after 18 months in medical school, the idea of being busy is less a point of pride and more a necessity. What has been far harder for me is to ensure that whoever is on my calendar gets my full attention for the time that I have them. My idols at Penn have been champions at this. I’m constantly amazed when the Chief <insert title here> Officer takes a few minutes out of their day to meet with me (I email faculty asking for life advice far more often than I should probably admit), and they spend those few minutes, however small in number, completely focused on me and what I have to say. If they can do it, there’s no earthly reason I can’t do the same. When I go out with friends, I try hard to stay off my phone. If someone needs some emotional or moral support, I make sure I’m there and I’m there for as long as they need. It’s a particularly bad feeling to be vulnerable and simultaneously be conscious of a clock. Incidentally, I’ve found that anyone I’ve interacted with understands my schedule, and they’re already inherently conscious of the demands on my time; I’m almost never late. I hope to translate these habits directly to patient care in my career.
The personal realm
We’ve had classes in medical school dedicated to teaching us to be kind and compassionate towards our patients. Accordingly, my classmates are the most compassionate group of people I’ve met. I want to go a step further – success as a doctor involves compassion towards patients. Success as a person, though, means being compassionate towards myself and towards my friends and family. For the former, I’ve attempted a slew of personal improvement goals over the past several months. From taking care to eat well and exercise to giving myself the occasional mental cheat day where I do nothing but read a good book or watch some TV, I have had to slowly reprioritize health and wellness over academic achievement-- no easy task for me! For the latter—compassion towards my friends—these past few months have been a sobering lesson in how to be a good friend and how not to be a bad one. The experiences are far too many, but the lesson I’ve learned is this: knowledge will come (and go), but the impact we have on those around us lasts far longer than a solitary bad grade or a negative evaluation from an attending physician. By getting into medical school, especially a strong academic one like Penn, my classmates and I have shown that we are dedicated to the idea of achievement. In my observations, I’ve seen that school always gets prioritized but interpersonal considerations tend to fall by the wayside. For example, when exams come around, my classmates and I understandably become a little more stressed. But more often than not the anxiety levels become so high that we stop eating well and sleeping and being cognizant of how our stress is being displaced onto the people around us. We all get our studying done, but there isn’t as much of a premium placed on being considerate people during exam week. This wouldn’t be an issue if we went into exam mode once a semester like undergrads do, but in our preclinical years we had exams once a month and as we move into the hospitals, our stress level is constant, only to increase as interns, residents, and fellows. Forcing myself to spend a tiny bit of energy not taking my life out on the people around me has gone such a long way, even in the 2-3 months I’ve been trying.
The technological realm
And as a last and somewhat fun personal goal, I’m trying to be mobile-technology backwards. Today’s world of apps and large screens and The Next Big Thing is Here (credit to Samsung) makes it remarkably hard to disconnect. Technology comes with huge perks, but I was recently on a commuter train to New York and 80% of people were staring at their phones. I was shopping yesterday and the minute the line got longer, one by one people started pulling out their mobiles. I noticed one day that my environment resembles this far more than I’m comfortable. My personal attention span has dropped so low that even if I’m waiting for someone for five minutes, I have to start browsing (something that’s made listening to lectures hard). So I’ve made a conscious effort to put my phone down and away. I’m the awkward person now that stares straight in an elevator when everyone else is on their phone. I walk looking up when I’m on the street. This particular goal has involved eliminating mindless browsing. As a fun exercise, I challenge you to count the number of times a day when you’re staring at a screen and you unconsciously type “www.facebook.com” or a time-wasting site of your choice. To be clear, this isn’t deciding to be unreachable, just more mindful of what I use technology for. Doing so would allow me to put a premium on human interactions over digital ones. Furthermore, it will hopefully allow my dependence on technology to stop negatively affecting those around me, whether it’s a patient who’s feeling slighted because I’m typing away notes on a computer without looking at them or whether it’s a friend who’s trying to speak to me while I’m busy texting someone else.
Live in the now
As an undergrad I always had medical school in the back of mind. Now I could have residency in the back of my mind all the time-- it’s easy to miss the present in worrying about the future. I’m no longer waiting to start my career – it’s begun. The perspectives and habits I develop now will stay with me throughout my career. All of my above measures of success have one theme in mind – live in the now. Cliché as it is, the past 18 months have been one long exercise in enjoying the ride instead of fretting about the destination. Better to change how I think through medical issues rather than worrying about how my grades seem on a transcript. Better to be engaged in a given interaction than worry about the next thing on my calendar. I carry around a fortune in my wallet: “Hardly anyone knows what is to be gained by ignoring the future.” Note that there are two meanings. As medical students, we tend to live by the one that says ignoring the future is terrible. As for me, I try to live the interpretation less traveled: few realize how free one becomes by forgetting about The Next Step, just for a little while.
Few realize how free one becomes by forgetting about The Next Step, just for a little while."