Acknowledging the Competing Incentives in Medical School

For many medical students, especially those without specific predetermined career paths, finding passion and purpose through medical education includes navigating through many maladaptive impulses that exist in the process of obtaining a medical degree.
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Sitting on a hospital ward bed medical student consults notes
Sitting on a hospital ward bed medical student consults notes

The rigorous four years of medical school is often heralded as the most defining period of a physician's career. It is a stage of marked intellectual and emotional transformation; what was a college-degree neophyte adept at biology and test-taking soon emerges as a novice physician ready to train in the art and science of medicine.

Medical school is often branded as the time to "find oneself" in a career focused on patient care. For many medical students, especially those without specific predetermined career paths, finding passion and purpose through medical education includes navigating through many maladaptive impulses that exist in the process of obtaining a medical degree.

Below are a few examples of such morale-busting distractions that a medical student early in his or her education should recognize and attempt to stoically endure or, if possible, avoid altogether.

Competing with colleagues

As a medical school survivor, I know first-hand how competitive medical school can be. By placing a cohort of mostly type-A, over-achieving individuals in an academic curriculum mostly graded on bell-curves and subjective evaluations, medical school can often make you feel like you've fallen into a shark tank with an open wound. To make matters worse, the increasing number of medical school positions across the United States puts that much more resident applicants in a pool competing for only a limited number of U.S. residency positions. (See here for more on this).

Despite the intrinsic drive to compete academically with colleagues and the extrinsic pressures to ensure a good class ranking by the time one applies for residency, it is essential that students do not focus on academic competition as one the main drivers in succeeding in medical school. If one does, he or she may run the risk of burning bridges with future colleagues and miss developing integral collaborative skill sets that are definitely required throughout the rest of medical training and beyond.

Evaluation burnout

The scheduled curriculum varies among medical schools, but the third year is often the most defining of the four years, as it is the first time medical students largely leave the classroom and dive head-first in the role of a clinician. This period of medical education serves to help facilitate career interest by escorting medical students through various several-week medical and surgical rotations.

Unfortunately, this year also comes riddled with so many clinical and academic evaluations that it can make your head spin. While students are urged to find their clinical interest in medicine through various specialty rotations, they must do so while being tightly evaluated by their assigned medical teams and through a spectrum of specialty-specific exams known as "shelves." The plethora of performance measures often brings competing incentives to the medical students, who, beyond patient care, must find time to study for the exams during their limited free time and attempt to make a good impression with the medical team during clinical rounds. Unfortunately, much of this evaluation is away from where medical students should be the most: the patient bedside.

While it is important to find dedicated study time for the shelves and to make oneself helpful to the assigned clinical teams, it is equally imperative for students to stay attuned to their clinical interests and, most importantly, to the patients relying on them for care.

Take home point

Like many careers, medicine certainly comes with its own hoops that one must jump through to reach the next stages of the profession. Many of these distractions are intrinsic to the process of obtaining a medical degree and thus are unlikely to change, at least in the short-term. To help facilitate purpose and morale and reduce burnout, it is important for medical students be cognizant of these pitfalls in medical education and to maintain focus on why they went to medical school in the first place: to find joy and purpose in the field of medicine.

Originally written for LeadDoc

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