In theory, entering medical school with a good friend should be a unique and enriching experience. Friends can become study partners, expand each other’s networks, and explore the same paths in terms of clinical rotations, research, and eventual career choices. Because medical school is a transformative period, and personal lives may undergo many changes — balancing relationships, family commitments, and career development can be challenging, and friends entering medical school together may be better prepared to adapt to these changes in each other's lives. The level of support, collaboration, and understanding between them will play a significant role in shaping their medical school journey and the evolution of their friendship.
I entered medical school with my best friend and it became my worst nightmare.
I’ll call him Danny. Danny and I had been best friends since third grade. We had a lot in common: sports, music, and girls. He was six months older than me, and he had better luck than I did in all three categories. I was intensely jealous of him, but he never let on. My jealousy motivated me to compete scholastically, and I achieved higher grades than Danny in high school.
Danny stayed at home after graduation and attended a “commuter college.” I left town for a large university. Our relationship was on hiatus for several years. However, each knew of the other’s interest in medical school. We discussed it all the time sitting next to each other senior year in biology class. That’s when I first noticed the academic competition between us. However, our distant relationship during college dissipated that competition – so I thought.
Danny and I were accepted at the same medical school. Driving together daily to school renewed our friendship. We quizzed each other every morning on the way to school, and we spoke by phone every night to see which one of us was ahead or behind in assignments. We pushed each other really hard. Discouraging statements were designed to create an impression that one of was struggling when that clearly was untrue. We aimed to throw each other off guard and pretend we were falling behind in order to gain an advantage over the other person. Our friendship turned into a fierce rivalry, each trying to outdo the other in the basic science courses.
Our relationship was tested toward the end of the first year. Danny called me in a panic. His fiancée had just broken their engagement. He was too upset to concentrate and study for final exams. The dean gave him a week extension. I consoled Danny, as any good friend would do – one who understands that experiencing medical school together means they should share common challenges, triumphs, and milestones, and be there to help deal with any setbacks.
I took the final exams as scheduled and told Danny afterward that they were not difficult – and I truly meant it. The feedback eased his mind, and a week later he took the exams and did great. This shared experience should have strengthened our bond and created lasting memories. It didn’t.
As our third year of medical school approached, our relationship had cooled. Danny and I did not take any clinical rotations together, and we barely saw each other until graduation. At the graduation luncheon, we both received academic awards, but we did not acknowledge each other or our achievements. Although Danny and I did our residencies in the same city at medical centers separated by less than 10 miles, we never spoke again. Our friendship was over for good. Competition killed it. The pressure to excel academically, combined with the limited number of top positions in class rankings, created most of the competition between us. Certainly, our competitiveness in high school was kindling for the raging fire.
Rather than foster growth, camaraderie, solidarity, and any number of positive outcomes a shared experience can create, the stress and workload of medical school put an unbearable strain on our friendship. Our relationship could have deepened, as can happen when two good friends support each other through the rigorous demands of medical school, but instead we grew apart and chose to see each other as competitors rather than partners. We paid a steep price for competing against each other.
Competition involves the complex interplay of various psychological factors. I used competition as a way to measure my social and personal worth, based on how I stacked up against others. I was driven to accomplish goals and improve my competency. People like me with high “achievement motivation” often engage in competition to validate their skills and abilities and overcome insecurities. I also became competitive to prove my worth and boost my self-esteem.
Looking back through the eyes of an older, more mature person, I see many things I would have done differently. My advice to current medical students is to set personal academic goals, but do not try to outperform your peers. Realize that your classmates are not your competitors; they are potential teammates you can learn from. There is no medical student on earth who knows it all. Seek to pair yourself with students who may complement your weaknesses. I can assure you that many of those students will look toward you the same way as they begin to recognize your strengths.
Any competition that ensues should be healthy and for self-improvement. Leave your “cutthroat” ways at the doorstep. By all means, opt for pass/fail rather than letter grades. Pass/fail reduces stress and anxiety and, in turn, creates a less-competitive atmosphere, leading to an increase in collaboration and overall well-being. Pass/fail grading also lays the foundation for self-regulated learning so important to acquiring new skills beyond medical school. You need not worry about USMLE Step 1 and 2 scores and successful residency placement, as studies have shown no significant difference in outcome between letter grades and pass/fail grading.
Finally, I implore you to strike a balance. Competition should motivate you to excel, but it should not compromise the importance of collaboration and mental health – and certainly not pre-existing relationships. The ultimate goal should be to create a learning environment that fosters personal growth, knowledge sharing, and mutual respect between you and your classmates.
If I could tell Danny one thing today, it would be that I’m sorry for turning our friendship into a competition. I’m sure he would say the same thing.
Who was your best friend in medical school? Did you compete? Share in the comments.
Arthur Lazarus, MD, MBA is a former Doximity Fellow, a member of the Physician Leadership Journal editorial board, and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.
Illustration by April Brust