Contributed by Alfred Wong, Class of 2016
This week I am starting class and with it my first step of a long journey into medicine. Over the past months I have done a lot of reflection why but moreover how I got here, a place in one of the best medical programs in the world. So how does one know medicine is for them? And if so how does one best go about getting into medical school? Sorry, I am not going to answer these questions, partly because like many things in life there exists many correct answers to these questions, and partly because you have to answer them yourself.
What I am going to offer is something more useful and can be done even before you have the answers to those two questions: three process-oriented actions any aspiring doctor can and should do.
What you will read are actions that have contributed to my own long-term success not only as a medical applicant, but also as a person and professional going forward into my career.
The business of pursing medicine is onerous, challenging, and just plain tough at times. Many of you will likely fail before you get it right: I did.
First Prime Minister of Singapore, Lee Kuan Yew wrote that in his own learning he constantly, “benefited from the lessons others paid for.” I offer you a candid look at my own struggles, failings and the wisdom I have collected from so many others, with a hope that you may find a useful perspective.
These ideas are not original; but they do not need to be. Cynics might brush off these things as mere common sense; I remind them that in human history knowledge and wisdom are not like genes; they cannot be inherited and for that common sense has always remained uncommon.
“Those who lack courage will always find a philosophy to justify it.” - Albert Camus
The biggest disservice you can do is to pity yourself. Envying others for their accomplishments only serves to marginalize your own and impairs your ability to be constructive. Not to say that knowing whether you are competitive for applications isn’t healthy; but going beyond that is not. There is no such thing as a perfect candidate. Most admissions committees will echo this position. Know that accomplishments regardless of how prestigious, a presidency on a volunteer committee(s), graduation distinctions, a job in a well-regarded company, all represent the past. Have you noticed how the cleverest people at school are not those who make it in life? The future will be determined by your desire to succeed and the actions you take today to succeed.
Another disservice is yielding to thoughts of being left behind because your friends have all gotten into professional school on their first try. Many practicing physicians I have asked over the past five years frankly said that the race to get to medicine is an empty one. Furthermore, these accomplished physicians are in careers spanning three decades, and some have retrained beyond medical school, what does it matter if you have to take a year or two more getting in? What does it matter if you need to take the MCAT again? Self-pity can even come at the admissions interview. In the company of so many talented candidates and hearing so many inspiring life stories might make one feel overly modest about oneself and feed an urge to explain why one’s accomplishments are not as good as others, or why these achievements could have been better but were not,as if making the committee feel sorry for me will inspire them to give me a spot. This thinking and behavior is all self-defeating and is why I failed my own interviews the first time. Some of my interviewers later said that my achievements were not the limiting factor; the limiting factor was that I didn’t inspire confidence that I knew medicine was for me; that I believed in myself. No wonder because I had beat myself up with so much self pity.
What did help me was identifying and cultivating what I had to offer and being great at it. Achieving excellence in my strengths is what set me apart and gave me self-confidence over self-pity. After failing my interviews, I refused to see myself a victim of bad luck or circumstance; and I focused on the only thing I could control: my actions and my performance. I decided use my savings to move to Toronto: to find that opportunity.
After five failed applications elsewhere I was accepted as a volunteer at the Anne Johnston Health Station; a community health centre. Over two months, I supported seniors healthy living programs, designed and published marketing, represented the centre at health fairs and authored the first comparative qualitative review of competing Diabetes programs done in five years. It would be wrong to assume that I was completely comfortable, certain of the future, or succeeded all the time. I was never promised that I would be given work that would match my experience, nor that the work would have relevant medical experience. However, I was willing to learn gradually and earn trust with others; I was willing to create opportunities to use my strengths. Most of all, I made every opportunity count regardless of how small or modest, into an example of excellence. My contributions caught the attention of staff and management and I was hired as the full-time Coordinator for the entire Diabetes Program working directly with program clinicians.
In our efforts for excellence far too few of us recognize that failure is a prerequisite for achieving it; failure is a healthy part of life and you should never feel sorry about a first failure. If you are failing it means you are pushing your horizons doing something that is new to you. It can be easy to forget because many undergraduate programs do not exactly promote and encourage this kind of learning. One example of these manifested attitudes is the admission policies of professional programs that rely too much upon the culminative GPA score to rank potential candidates. This approach places students taking innovative courses or who struggle in early years while blooming academically in later years at a significant disadvantage. The impact of such a culture and policy so tilted towards past success has large implications for society. The opportunity costs in the numbers of overlooked candidates who would have been great productive professionals; moreover the downstream cost of these attitudes and behaviors perpetuated in those that are selected. In many environments we are given the message that making mistakes is not normal. Students become so paranoid and anxious about failing that they don’t end up taking the good risks and challenges that will grow them. These students are ill equipped to be innovative: to be resilient, to be confident, to challenge the system. Education systems that perpetuate this idea of continual success yet omit or remove failure from the learning process distort reality and handicap their graduates. In clinical medicine mistakes are a reality because therapies and medicines are often both beneficial and harmful, diagnoses are uncertain, resources limited. Dr. Brian Goldman, emergency physician at Toronto’s Mt Sinai Hospital offers a candid view at the internal turmoil and how unprepared many medical professionals often are in facing errors: the stakes are very high.
“Underneath is this terrible insecurity that many physicians feel, that they’ll be caught out on a mistake and people will find out that they are not perfect, and somehow admitting their mistakes is the first step in being asked to leave the profession. We’re ashamed to talk about it.” [i]
De-stigmatizing failure, using failure as a learning opportunity is the current cutting fashion in the popular business literature and the ongoing challenge in medicine; however, it was over a thousand years ago that Confucius who in his sage wisdom said that;
“One who makes a mistake and does not correct it; is making another mistake.”[ii]
That is if you can learn from your mistakes be it a bad interview, a failing exam mark, a damaging assumption on a colleague then you have gained not lost ground. In fact many software executives in silicon-valley say that people who have failed in life often make the best software CEO’s because they know how to avoid future failures… think Steve Jobs[iii]. In medicine the best doctors learn from failure when they make the wrong diagnosis or a bad call in the ER. Dr. Atul Gawande, a practicing surgeon in Boston Massachusetts who writes for the New Yorker on medical practice, detailed how the whole specialty of anesthesiology in the US was transformed in the mid 1970’s to the 1990’s by a process of systemically identifying, documenting and analyzing errors in anesthesia; the attributed death rate fell to a twentieth over a ten year period.[iv]
Leaders and researchers have proven quantitatively that current success is a dismal predictor of future success[v]. On the other hand, failures can have great future value. Facing up to your errors takes guts because it means that you are taking ownership of the error, not blaming or explaining. It means that you are willing to ask and take constructive criticism to improve the way you do things. It means that one goes beyond being sorry and actually does something to address a shortcoming. No surprise that, “tell me a time that you failed, and what you learned from it” remains a popular interview question across industries, worldwide.Accordingly within innovation industries, persons’ whose curriculum vitae are filled only with safe successes, devoid of any failure may find themselves judged with skepticism. Before putting yourself in that interview chair, remind yourself of this reality. Excellence in my own life followed from not avoiding, hiding, or despairing about my shortcomings; but rather putting that failure into perspective and using it to self-correct; you can too.
Yes, it’s far easier to be in self-pity than to be self-reflective and corrective. We all have our own pasts and circumstances these cannot be changed; but we can control our thoughts and actions today. Remember that being sorry for yourself is to be in self-defeat; however being self-corrective is to be a champion and strength to others. What will you be?
[i]Erin Anderseen, “When doctors make bad calls”, Globe and Mail, Feburary 24, 2012, Saturday Edition
[ii]Cleary, Thomas,The Essential Confucius: The heart of Confucius; Teachings in Authentic I Ching Order, New Jersey NY, United States of America, Castle Books, 1992.
[iii]Isaacson, Walter,Steve Jobs. New York, United States of America: Simon & Schuster, 2011.
[iv]Gawande, Atul,Complications: A Surgeon’s Notes on an Imperfect Science. New York, United States of America: Henry Holt and Company LLC, 2002.
[v]Collins, Jim,Good to Great: Why Some Companies Make the Leap and Others Don’t. New York, United States of America: HarperCollins Publishers Inc, 2001