To the Editor:
The quintessential “good” medical student isn’t difficult to picture. Her dedication borders on obsession and pays dividends in the form of excellent marks, supervisor praise, and the knowledge that she is responsible for raising the bar out of reach of the rest. “Good” medical students usually also count flashcards among their brief list of hobbies, and are those for whom sleep deprivation is a competitive sport. Success in medical school is almost wholly defined by exam results, and there are no bonus marks for being well rounded. However, whether extreme dedication alone is ultimately enough to make a good doctor remains to be seen.
Academic achievement is a key aspect of most medical students’ identities. Unfortunately, upon starting medical school many students experience the difficult realization that they have moved to a different part of the bell curve than the part to which they have been accustomed. The desire to ascend back to the pointy end is readily appreciable. Unfortunately, the qualities that facilitate this, and those that are valued throughout medical school by the culture or curriculum, are also those that predispose us to burnout and a poor work–life balance. Mental illness is becoming an occupational hazard of medical training.1 Considering the narrow definition of the “good” medical student that we internalize from our first day, along with the internal and external pressures to achieve this status, it is not difficult to imagine why this might be.
The “good” medical students may become successful doctors as judged by the formidably high standards of the profession, though it may come at a cost to their personal well-being. However, the qualities that this process fosters are not necessarily those that patients identify as most valuable, such as communication skills, patience, and empathy. It is indisputable that aptitude is vitally important. A medical student who can’t tell aspirin from adenosine isn’t just failing to meet the criteria of a “good” student, he is a danger to patients. However, it is also possible that the cost that we are willing to accept to produce the best and brightest is immense, and is not always in our future patients’ best interests. Considering this, if we thought about the pervasive attitudes that inform our definition of a “good” medical student as a disease, it’s hard to believe that we would not try to treat it.
Third-year MD student and MPhil candidate, University of Sydney, Sydney, Australia; [email protected]
1. Dyrbye LN, Thomas MR, Shanafelt TDSystematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81:354–373.