Control and Comparison: Thoughts from a Recovering A-type Medical Student

This summer passed quickly and quietly, and we came back to medical school far less enthusiastically than we did last year. Within days of starting, second year proved to be a bizarre coalescence of didactic monotony, quasi-clinical applications, anxiety-provoking spiels about board exam preparation, and discussions of rotations that are just close enough to excite us, and just far enough away to taunt.

Ironically, the closer we come to finishing the didactic years of medical school (supposedly the most miserable part of this process), the more anxiety I’ve felt about what’s to come. If you casually eavesdrop on any conversation, you are bound to hear the braggadocio of students recanting their revolutionary clinical research project, the pride of students who have meticulously crafted a perfect board study plan, or the distress of a student that looked at their class rank and realized they are, for the first time in their life, not the valedictorian of the class. Don’t get me wrong, I’m ecstatic for my peers when I hear about their phenomenal accomplishments, and I am overwhelmingly proud to be classmates with these incredible future physicians. Truly, these people are some of the most incredible people I’ve ever had the privilege to know. But frankly, it’s overwhelming to realize that for the rest of our career, we will be compared to each other as a measure of our worth. Whether it’s board scores that are normalized to a score that gives percentile rankings, applying to residencies, or securing jobs, this is the normal physicians face for the duration of their career.

So, in the face of constantly imposed comparison, how do you cope? How do you answer the question: what if my best is not the best?

I don’t have a magic formula, but here’s what I have so far:

You cannot control how others perform. Quite frankly, the better we do as a whole, the better the care our future patients will receive, so this is a fundamentally good situation.

You do not have to subscribe to the notion that your worth is intrinsically tied to how you compare to others. Your worth is derived from so many beautiful and wonderful characteristics and qualities that are all innately you. Don’t let an institution cheapen how you view yourself.

In the upcoming years, there is very little that you can control. You can stress ad nauseam about all the factors that are out of your control. I’ve done this all week, and the list of things to stress about has exponentially increased with each passing day.

Despite the perpetually increasing stress and anxiety, those things will forever be out of your control. It’s quite paradoxical, really. Once I realized that the anxiety was accomplishing precisely nothing, I decided to start focusing that energy on the things I did have control over — doing my personal best to accomplish the things that are in my control, managing my time as optimally as I know how, taking care of my health, and clinging to my humanity as we enter this potentially soul-crushing process.

As I transitioned to this new stream of consciousness, the serenity prayer came to life in ways I had never considered. In fact, I wrote it in my office but adapted it to fit the needs of a recovering A-type medical student who simultaneously demands perfection and control.

God, give me serenity and peace around the things I cannot control. Give me courage, dedication, perseverance, and motivation to strive after the things that are in my control. Give me wisdom to discern the difference. 

How have you coped with these institutionalized comparison traps? Or just the entire medical education system in general? I’d love to hear your thoughts.

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