It’s fall, which means interview season. Each year we interview dozens of applicants for 15 open positions at our training program. These interviews are brief (20 min). I make an honest effort to get to know the applicant and assess the likelihood of success. Typically, I save time at the end for Q&A. One of the most common questions I get: “What advice do you give to incoming residents to be successful?” I used to answer this question with enthusiasm. It feels good to share your experience with young physicians. At the same time, it feels like you’re giving away something for free. I want to say; “Why don’t you come here and find out!” But there’s a good chance that wouldn’t go over well…
Anyway…onto my typical answer.
Attributes that tend to lead to success, in my opinion, are reliability, discipline, curiosity, openness, self-reflection, observation, and freedom from ideology. You don’t have to be exceptional at all of these, but it helps to have at least a little from each. You can imagine dealing with someone that lacks a component of this recipe. It would make you want to pull your hair out.
As an example, we can flip a couple of them to demonstrate certain failure. Someone that is considered unreliable, routinely showing up late, or not showing up at all, is likely to flunk out in spectacular fashion. You can’t rely on that person. Always covering for them at the last minute. It’s a huge headache. Eventually, it’s easier to not have them around. Same as someone hell bent on a specific ideology, and only views the world through that lens. Everything that happens goes back to their belief structure. Including the bad stuff. There’s always someone, or something, to blame for their misfortune. These individuals are difficult to work with. Their narrow view hinders their openness, dampening other potentially redeeming qualities.
These are all smaller pieces of a much broader idea, the idea of suffering with purpose and direction. This is the construct that lays the foundation for the positive characteristics above.
I read something the other day that helped summarize this concept.
It was written by Wilfred Thesinger. Thesinger was an Arabist (apparently those existed) traveling with nomad tribes in the Arabian Desert during the early 20th century (1910ish-1920). Speaking of one tribe, known as the Al Murra, he had this to say:
“For untold centuries the Bedu lived in the desert; they lived there by choice…All of them would have scorned the easier life of lesser men. Valuing freedom above all else, they took a fierce pride in the very hardship of their lives, forcing unwilling recognition of their superiority on the townsmen who feared, hated and affected to despise them. Even today, there is no Arab, however sophisticated, who would not proudly claim Bedu lineage.
I shall always remember how often I was humbled by my illiterate companions, who possessed in so much greater measure, generosity, courage, endurance, patience, good temper, and lighthearted gallantry. Among no other people have I felt the same sense of personal inferiority.”
Amazing how simple the human condition is, yet so counter to what most would consider a road to happiness. Assuming hardship, with a group of people, sharing a common goal, testing one’s limits, surviving the most difficult situations. Suffering with purpose and direction.
I was fortunate to be one of the final trainees to experience life before the ACGME instituted regulation in the name of patient and worker safety. There were 30-hour call days in the ICU. Overnights on the medicine ward, cross covering after a long day of admissions, running codes and rapid responses at 4 in the morning.
In Detroit, where I trained, there was a bar on Woodward Avenue called “The Blarney Stone.” It used to open at 9am. From time to time, the team would go there after a call night, grab a beer, share some jokes, then head home to get some rest. We suffered, but we suffered together, taking care of people, learning from each other, surviving. I have quite a bit of pride from surviving these nights.
It should not surprise us when an old-timer hospitalist, or Neurosurgeon, or a seasoned ER physician walks around prideful. They have suffered. They’ve suffered a great deal for their craft. They suffered with their tribe. Learning from each other, taking care of people, surviving. You can tell the one’s that got into a field strictly in pursuit of this. To test their limits. The one’s that answered the call. The call to climb Everest, risking life, and limb, to prove it to themselves. There’s an air of confidence about them.
I’m not saying the entire career of physician should be insensible suffering, but there should be a period that is hard. Proof to yourself that you can handle it. Good weather, bad weather, hungry, tired, doesn’t matter. You can step up and do the job. That’s where pride is born. That’s where confidence is born. In the hard times.
So, my advice would be to pursue the things you find difficult. Do not shy away from a challenge. Do not be satisfied with getting by unnoticed. This would waste the experience. Do that which is hard, with your colleagues, on a daily basis. Suffer together, take pride in your suffering, and the rest should fall into place.
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