Standing Together


I was recently speaking with an older physician. He carried the wrinkles of wisdom chiseled into his knuckles and etched on his forehead as he raised his eyebrows to speak. We were talking about the new era of medicine and the shape of the health care field to come. “Things have always been competitive,” he said, “that’s just the nature of the beast.”

He went on to describe how when he was going through medical school, before the generation of laptops and wireless Internet, students went to the library, borrowed books, and learned solely from paper-and-ink resources. In those times, there were usually more students than available texts, and thus began the culture of competition. Some of the most prestigious institutions were notorious for educating the most cutthroat students—students who would literally rip pages out of library texts so that none of their peers could even have to the chance to realize what they did not know.

Of course stories like this are troubling, and I’d like to think the current culture of medical education has long matured from this kind of behavior. In fact, these days access to the Internet makes the monopolization of knowledge virtually impossible. But is this competitive model of medical education becoming history? Is a more collaborative model even possible given the nature of the current health care system? Perhaps answers to these questions are not so clear, but what is apparent is the value of the student collaborator in the coming age of medicine.

The competitive student has classically been known as a ‘gunner’. He or she often fits the typical description of a medical student: driven and self-disciplined, perhaps even to the point of ruthlessness and major self-sacrifice. They are more inclined to think about improving themselves before all else, and often seek success at the expense of their peers. The fitting question then, is what kind of doctors do these students become? If their motivation continues to exist at the cost of their colleagues, they risk becoming less effective and even obsolete as physicians in a system that is rapidly becoming more team-oriented.

And what about the collaborative student? These are the students that often find themselves engaging in many extracurricular or volunteer organizations. They have often been described as personable, socially adept, and strong in their ability to organize, persuade, and impact groups of people. These are the students willing to take on challenges that work toward the benefit of their class or community as a whole. The collaborative-thinking student functioning within an equally balanced academic model is where, I think, the future of medicine holds its promise.

The coming era of medicine will prize individuals who have the keen ability to work in trans-disciplinary groups; who can coordinate a diverse team of professionals to achieve a defined and collective goal. They are the ones who can relate much more confidently with patient populations and possess the natural ability to put others at ease. My argument here is that the old philosophy of self-achievement and personal gain inherent in the competitive model will soon become irrelevant. Clinical programs are looking for students who have strong scores, yes; but increasingly favored are students that can recognize, attend to, and navigate through clinical situations with a procedural tact that can only be taught by a wealth of experiences. Similarly, our communities need doctors who are also leaders, and so we must start producing these students. Training students to ally with their peers and partner with their communities early makes strides in the direction of relieving the health disparities in this country.

The physician I was speaking with seemed tired, like he was carrying the weight of many years and many stories deep within himself. “Don’t ever give up on what you set out to do,” he said, “but if you lean to one side too long, you’ll lose your balance.” I liked this last part. If we redistribute the weight of a teetering system, we can easily bring it back to stability. We just have to look at how we’re standing.



Christopher Salib, MSII



2 thoughts on “Standing Together”

  1. I personally think there is much benefit in shifting to a collaborative model of teaching since it mirrors what is to come in the workplace, where success very much depends on being able to communicate and understand others. However, I doubt that the collaborative model actually eliminates “gunners”, or other rogue competitive behavior. I would argue that in light of free market access to educational resources (via the internet), students will nevertheless finds methods to give themselves an edge over their peers. So what does this look like in a world where we are taught to play nice with classmates? In my opinion, the use of cognitive stimulants such as Ritalin are today’s equivalent of ripping out pages or inadvertently dropping a banana peel on the ground. In fact, “mental doping” is more dangerous than our historical pen-and-ink tactics. This is because the use of stimulants is not self-regulating in our social environment. Before, if a student ripped out pages of a textbook, he might be found out or might even feel guilt. The possibility of social exposure is the “invisible hand” that worked to correct this undesirable fringe behavior; at least more so than a student secretly popping pills before a cram session. Furthermore, the fact that the mental doper can give himself this edge, unbeknownst to anyone else, he risks no social consequences that are demanded of our new collaborative model. He can go about his group projects, cocktail hours and study sessions under the assumption that he is a team player. And surely, he is. No one doubts that. But, with this mental steroid, once again the playing field is uneven. The starting line is staggered. The gunner benefits from both worlds and bears no immediate risk. So while graduate programs are seeking to move away from competitive tendencies, I believe that competition is so engrained in our psyches, that students will inevitably find other ways to achieve a “better” outcome than their peers.

    How pervasive is mental doping? I don’t have any hard figures to present. It is certain though that it is a growing problem. It speaks to legitimate issues of fairness and integrity that ought to concern any professional.

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