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Medical Trainees, Are You More Concerned With Being the Best or Your Best?

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My medical school training was transformed when I was introduced to the growth mindset, the concept where one believes that their abilities can improve over time with intentional effort. It was a necessary perspective shift for me where I had to ask myself: am I mainly motivated by a desire to learn or do I just want to look smart? My initial response to the stress of medical school was the latter, which is characteristic of a fixed mindset — the contrary concept where one believes that their abilities are innate. The new breadth and pace of the medical school curriculum initially felt overwhelming for me. Confidence shaken, my concern for appearing knowledgeable amidst brilliant classmates and proving my place became acutely pronounced, and this fixed mindset began to hinder my ability to truly learn. 

I remember initially struggling in our physiology course during my first year. During discussion sections on pulmonary physiology, I quickly realized that I had not really grasped the concepts from the lecture I just attended. As I watched classmates seemingly breeze through practice questions, I wondered to myself why I was not more apt in picking up lecture material. I grew hesitant to participate freely in class, withholding questions out of concern for appearing less knowledgeable. When I received feedback on my responses to questions, I focused more on the shame of being critiqued rather than the valuable instruction I received. I began to consider that maybe I just wasn’t good at physiology. Although I continued to keep up with the class, my motivation dampened. And the increase in activation energy needed for me to study led to an inefficient use of my time, as well as a neglect of other extracurriculars in my life that kept me balanced. After seeing a stagnancy in my first two exam scores, I reached out to a faculty advisor for general tips on managing my course load. In receiving feedback on my approach for the class I was most concerned with, I learned that I had a fixed, performative mindset that was curbing my learning experience in all of my classes. In order to cultivate the growth mindset that he described, I learned that it was important to learn to see opportunity in critiques and mistakes, view learning as more than a set of goals, and invest in my holistic wellness. 

In acquiring new skills, one often may not complete the task correctly — or most efficiently — the first time or even the second time. The first time I performed a subcuticular suture in the OR was nowhere close to being as fluid as the work of the chief resident suturing across from me. Getting better at this skill required both practice and my ability to readily incorporate critique. It is easy to absorb early evaluation in a way that focuses on current proficiency rather than seeing an opportunity for improvement. But having the latter viewpoint has helped me listen to and incorporate tips on techniques that have made completing this suture more efficient with better results in skin closure. When receiving feedback, it is easy to focus on how your performance stacks up compared to peers (or even the instructor) instead of focusing on key points that add to your knowledge and understanding. I began to ask myself: am I more concerned with appearing to be the best or with becoming a better version of myself? In choosing the latter as the priority, the growth mindset primes one to regularly seek feedback and view feedback constructively as learning opportunities. Setbacks are then seen as stepping stones rather than roadblocks. This mindset recognizes that mistakes are a natural part of growth, which helps limit the shame or sense of failure that clouds one’s ability to capitalize on the learning moment and continue to persevere in the process. 

Being process-minded is the key to recognizing that learning is a journey and not a destination. Performing well on an upcoming test or board exam is not the ultimate goal in medical school or residency. We should expect to be lifelong learners in order to continuously improve care for our patients. And as we pursue mastery in our chosen fields, there will always be more to know — new presentations of illness, new procedure techniques, and new literature. This can feel overwhelming. As medical trainees, we are committing ourselves to not just medical mastery but also the pursuit of new knowledge. As an attending surgeon once told me: none of us are finished products. We’re all learning, albeit at different stages, but all still works-in-progress. Holding onto this perspective has helped me look forward to each day of training, knowing that I get the opportunity to know a little bit more than I did yesterday. 

The medical training process is long and can span more than a decade for some of us. A growth mindset recognizes the importance of fostering holistic wellness in order to fuel our endurance in training. Within the performative mindset, one becomes so fixated on looking good on the clinical stage that the other parts of oneself become neglected; this has left many of us feeling burnt out. It is important to realize that the components of professional and personal growth are complementary and not adversarial. Prioritizing sleep allows me to be more efficient and productive when awake, despite how tempting it may be to squeeze in an extra hour of studying. Setting aside time for exercise — even a quick 30-minute run — pays dividends in alleviating tension that can curb focus during work or interfere with the ability to rest. Furthermore, maintaining quality time with a support network — phone calls with friends, dinners with family, and hikes with co-interns — creates a steady source of encouragement that pours into my reservoir of motivation. In these ways, holistic growth sustains academic growth. 

During the following renal physiology section in my medical school course, I intentionally practiced the components of the growth mindset that my advisor shared with me. I made the commitment to unabashedly ask questions to both peers and faculty. The instruction I received allowed me to incorporate more efficient study practices and helped me better understand the material. With a viewpoint of preparing for the marathon of continued learning and not sprints from test to test, I became excited rather than intimidated by the new concepts I was to learn. The self-commitment to protected sleep and exercise time allowed me to better absorb the information I was learning and feel energized to keep moving forward. And the renal physiology exam ended up being my best performance at that point in medical school. Since then, I have continued to approach my learning with a growth mindset, carrying this perspective with me into the new rigors of surgical residency. 

In both medical school and residency, I have been in conversations with trainees sharing all too familiar experiences about how the desire to look intelligent to peers and seniors and fear of making mistakes generates anxiety about performance, making it hard to stay motivated and continue pushing oneself. Given the arduous nature of the training process, keeping a growth mindset is important in any field and stage of training medicine. I hope we continue to foster a growth mindset as a cultural value in medicine, encouraging trainees to embrace challenges as steps to personal improvement, keep perspective of the process, and maintain holistic personal care.

Dr. Nzuekoh Nchinda is a general surgery resident at the University of Washington who is passionate about health equity, quality improvement and outcomes research, and ethics. She completed her medical school education at the University of Chicago and undergraduate studies in chemistry at Harvard University. She enjoys knitting, running, and singing in her free time. She is a 2020–2021 Doximity Op-Med Fellow. She reports no conflicts of interest.

Illustration by Jennifer Bogartz

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