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In Medical School and In Life, You Get Out What You Put In

This morning I sat in grand rounds among the entire department. Like most people, I often experience a hesitancy to attend events that require me to wake up early (and thus lose already scant moments of sleep). But once there, I remember the allure of it all…

It’s as if I’m transported back to a 1900s lecture hall, surrounded by the sound of our physician forefathers’ esoteric discussions of medicine. I can’t help but feel inspired by the vast array of knowledge that our academic attendings possess.

Oftentimes the voice of Sloth whispers into my ear, “You can pump the brakes a bit. Take it easy. Let your guard down. You don’t have to work so hard!” But when I hear the brilliant speakers during these weekly sessions, my desire to have absolute understanding of the medical field is re-ignited.

I want to be the smartest guy in the room. But how does one get there?

By doing whatever it takes to advance his or her knowledge as much as possible every day.

Sounds simple, right? Just work really hard and you’ll do just fine. But excellence is so much more than a job well done. And when your decade of training between medical school and residency is complete, do you want to be a good doctor? Or do you want the ability to confidently declare that you are one of the best?

As Lao Tzu reminds us, “A journey of a thousand miles begins with a single step.” Your journey through medical school and residency will have thousands of small steps. In fact, give or take, you will have 3,000 days to assemble your fund of knowledge before you’re granted the status of attending. And if you choose to go the extra mile 3,000 times, you’ll cross the void between satisfactory and remarkable.

While we talk extensively about excellence in test prep, let’s focus on getting the most value from clerkships:

I frequently think back to my first rotation — Neurology — and how it was divided into two teams: stroke and neurosurgery. The stroke team was the “easy team,” where days ended by 4pm, and if you got really lucky and ended up with the “cool” chief resident, you could probably get out by 2! Alternatively, the neurosurgery team was often there until 10 pm — scrubbed into craniotomies, observing from a distance with their arms folded for 6 to 8 hours.

I’m sure your medical school has analogous “easy” and “hard” rotations – no matter which group you find yourself in, there’s a way to advance your knowledge. Home at 2 PM? READ. Read read read read read. It’s the simplest and most effective way to broaden your knowledge base. When the clinical exposure isn’t there (and sometimes it won’t be), pick up the slack by hitting the stacks and reading. Build the habit in medical school during your rotations. As you move forward into residency, the demand to read will be much less circumscribed and more self-directed. It is imperative to foster the drive to read early on in your training.

Now what about those frustrated students who are captive in the OR and don’t have time to read?

This isn’t the time to be timid! Ask questions, do whatever you can to get involved, and observe the surgeon’s techniques. Take the time to become ultra-focused on each incision and suture. On the other side of the curtain, you have a physiology master (anesthesia!) who is trying to maintain cerebral perfusion pressure with a combination of physiologic and pharmacologic manipulations. Watch how the scrub nurse gowns and gloves herself. Appreciate that the circulator grabbed 0.5% bupivacaine for local analgesia. The learning opportunities are endless and they are all around you.

It’s easy to write things off and say, “I’m not going to drive myself into the ground learning about neurology. I’m not going into it.” However, as your career advances, you will notice the incredible overlap between all medical specialties. The more knowledge you possess about other areas of medicine, the better you will be able to serve your patients. You will also be able to use consult services more effectively and appropriately.

The desire for excellence – call it “motivation” – is a difficult thing to cultivate, especially when rotations and test prep are running us down. We often feel burned out and simply cannot put together the effort to go the extra mile. If it’s not there every single day, that’s all right. That’s called being human!

That being said, only you can produce this motivation, this desire to be great. As often as possible, do what you can to rise above tiredness and apathy to get out there and become great at your chosen profession. Not only will you be building your knowledge base every day, but you will be building a habit of diligence and discipline that you can carry with you throughout your career. There is no substitute for hard work and the extra hours you put in today will pay dividends for years to come.