I should be working on my papers but this thread resonates heavily with me, so I'll add my own bit here.
- To the original poster, since you said you like reading stories here you go. Enjoy.
- Another poster said that he graduated at the top of his class in college, only to be humbled by the opposite in medical school - happened to me too.
- Another poster felt that their accomplishments had nothing to do with science, and fears being a bad med student. You will be a bad med student only if you believe that, and allow it to happen. A good friend of mine during med school had a business degree and after the first day of lectures in year one, especially with biochemistry, shesh after day 1, she was going to bail. But she did fine through med school, never got into academic trouble, landed a nice residency spot.
- As for the perception of board exams having that much power over one's career, you can choose to believe it if you want. I just don't share that view. One of my best friends in med school had a very tough time academically, was always in the bottom 25% percentile. She failed Step 1 boards, which to most med students during my time equalled "the end". Well, she's a great person and was able to overcome her score on step 1 boards during clinical years, showing her interpersonal skills, her dedication, and just how fun it was working with her. She matched into her field (a competitive one), and today is an attending at MGH. Because of her experiences, I ask her "so when you look at the resident applicant pool, you ever look at the scores", and laugh because everytime she will say "Nope". She also didn't have to sell her soul to get to where she is. Today she's also got a great family with husband and kids. I also know another MGH attending who failed Step 1 boards (he was working on a software startup at the same time, which probably explains why), but still got into residency at MGH and today ia writing so many key papers in the literature and asked to talk at so many national conferences.
- Apologies in advance for MGH references, it's just where I've been. Big difference between saying MGH, as a location, vs a way to boast or validate one's self-importance. I used to joke about how much I get annoyed by people that say "Well, back when *I* was at the Brigham....". At least now I can say "Well, I also was at the Brigham, and you're full of it."
- Pranks - I've always been a supporter of awesome pranks, but there's a careful line that you cannot cross. If it involves a call to 911 and police/firefighers end up wasting time instead of doing what they are supposed to be doing, well, you can't do that. You also have to think about professionalism in the sense that you're a leader, and people look up to you.
- Depression - if this could be a problem, please, don't wait to go seek help. Go earlier rather than later. Don't be afraid of stigma or stuff like that. If all you get is a script for pills, insist on counseling/therapy as well. Things will get worse and spiral out of control if you don't.
- Staying low, doing your thing, studying - unfortunately that's not going to keep you out of the firefights when they happen.
TL;DR Version - Crying during:
Med school: yes
Residency: yes
But there's a lot more to the story, so read on for the full story:
Super long version, entertainment included:
Medical school: Yes. Abused (but naive)
I gunned for a surgical specialty during medical school, from Day 1. My weakness that led to my "undoing" (i.e. not matching) was always wanting to help out fellow students, who would in the end, take advantage of my help, but never reciprocate. I was stupid, in that I was such an effective cheerleader for the specialty I wanted, that I got more classmates interested in the specialty (more than average applied for that specialty my year when the match came).
3rd and 4th years: The mature, emotionally secure housestaff were always great to work with. However, most housestaff that I had were still emotionally insecure, as they were also being treated like animals by the attendings. Those are the ones guilty of putting people down and feel people when they get the outcome they want (i.e. you cry or start quaking in your shoes). They are doing it because they can think they can get away it. Although true in my experience as a student, please understand it's not like this at many other institutions.
In contrast to those good housestaff, the malignant housestaff were toxic and would use medical students as emotional punching bags. Slave labor with no teaching. The more quiet/unassertive you are, the worse you'd get beat down (but you have to realize this is true everywhere regardless of healthcare/medicine - it's worse in places like investment banking). The pimping was incredibly lame - why should knowledge about minutiae (so specific as to have zero impact on patient care) make a person more respected? "Some towers just exploded, are you watching the news? Did you know anything about current events? Do you even care?"
It's said that "whatever rotation you're on, whether medicine or peds or whatever, you must say that's what you want to go into". Do they still tell you guys that crap in medical school? It's pure crap since you need to be true to yourself, but there is some truth to it. Insecure people get a certain sense of validation, that they "made the right specialty choice" when others tell them they want to join the same specialty. Mature people don't care and often will be happy you've thought out your decision, but those insecure individuals that needed the self-validation can get offended when you tell them that you want to do into ENT/ortho/derm/whatever instead. Especially in cheerleader like fashion.
When it comes to competing for residency spots, of course medical students aren't out there to be intentionally mean to you (at least most of them, unlike the saboteurs mentioned in earlier posts). Some specialties are just so competitive to get into, which fosters a "kill or be killed" mindset. I was naive, too nice, always wanting to help, but lacking ability to stick up for myself. Being nice got me nowhere. Eventually, I failed to match into the surgical residency I wanted, and the fellow students who bullied me to stay ahead got into those "coveted" spots. I felt so much embarrassment and shame when I didn't match that I didn't want to leave my apartment for days. Surely gossip was going around "Nori didn't match!!".
It sucked, but some awesome stories came out of the scrambling process for the transitional year of surgery, like hanging the phone up on the Stanford gen surg program director. I didn't have a choice - the residency director from the place I really want to go to called during my conversation with Stanford, and the administrative staff member said "Uhh.... uhh... just hang up on him! Hang up now! UCSF calling for you! Quick! Hang up on Stanford before UCSF hangs up on you!" (that office shenanigan becomes funnier when you learn that the person telling me to hang up happens to be Steve Carrell's sister-in-law, but I digress). So yes, I can say "That's right, I hung up on the Stanford program director", although it wasn't out of spite at all, and there was a Steve Carrell element to it.
Match day was the following day, and as many posters have already written, it's just a ceremony, and that's it. If you don't match into a program you like (but still ranked to avoid not matching), you can still change things - what you see on that match letter could be far, far what will actually happen. After you graduate, you will start to see the "residency shuffle", with people changing fields because things just didn't turn out the way they thought it would be. My year, when I was a surg intern at UCSF, something terrible happened at U. Mich, something like an ortho resident dying or committing suicide. So, an internal candidate from gen surg slid into that position. Then a classmate mine moved from Boston to Ann Arbor to fill that now vacant spot in gen surg. And then, a friend who cried on match day because he matched to a small community program, slide into that university spot in Boston.
As for "being nice", well, you should be. If you alienate people whether patients or other doctors, it'll backfire on you. Likewise, if you are too nice, it'll backfire on you - people will take advantage of you and not respect you. There's a fine line about being "firm but fair", and being assertive vs. being a push-over. Also, if you don't treat people right, nobody's going to be inclined to tell you about a spot that just opened up. That gen surg shuffle I described above was all word-of-mouth.
The subsequent year of surgical internship gave me a lot of stories I really need to write about some day, but suffice to say, I experienced what my feet feel like when standing upright for 12+ hours straight every day (enough to kill aspirations of a surgical career), and was pulled out of medical training after that for a few years (scholarship obligations, etc.). I saw the world, travelled, grew as a person. When I eventually returned to training, I had realized that I truly love medicine, that I love people, that I love talking to people - but simply didn't want to waste time on people who will argue with you about what they learned at "Medical University of Google, Department of Wikipedia, with Jenny McCarthy as Dept Chair". I had realized that in a work environment, I preferred talking to other healthcare practitioners vs. having the dispel pseudoscience from last night's evening news, or dealing with the latest seeker. Plus there were emerging, disruptive technologies in pathology that I wanted to be a part of and help drive the future of medicine. So, I went into pathology with the expectation I wouldn't be doing stuff like autopsies at all. And today, I don't.
Residency: Yes. Abused (but stood my ground, these unprofessional attendings either lost their jobs or moved on)
I was at a 3rd tier pathology residency program (formally top tier, but glory days are long, long gone). It was a small program, so I didn't experience any resident vs. resident competition, but the attendings were more toxic than the ones I experienced during gen surg. Goddamn it was bad. I was told a couple weeks before my boards that "no way you're going to pass, you don't know jack" (that particular attending was later fired, although for other reasons). The residency director was also known for pulling residents in these entrapment type of conversations, such as what happened to my classmate, who had a stellar base of knowledge:
Attending: "It was a nice weekend, what did you do? Anything fun?"
Resident: "Yes, I enjoyed the outside with my husband and kids, we went so-and-so places"
Attending: "YOU NEED TO BE READING MORE!"
Resident: /cries
But this time as opposed to my time as a medical student, I was willing to stand up for myself, stand up to the hostile attending. One time, I got paged into his office at 8:15am or so, in the middle of a resident didactic lecture:
Attending: "I can't believe you screwed up putting the specimens in the overnight processor, all of the surgical specimens are dried out, blah blah, we can't generate slides from them" (he exaggerated here just a little)
Me: "You're talking about a thin, tin handle being on the left side instead of the right side". (To those of you non-pathologists, this is like arguing about toilet paper roll orientation)
Attending: "YOU WERE AT THE TRAINING SESSION DOCUMENTED RIGHT HERE! HOW CAN YOU NOT FOLLOW INSTRUCTIONS!"
Me: "Well, perhaps there's a problem with how the current system works and how it's prone to error by anybody
Attending: (continue to throw ad hominem attacks for 10 minutes, I stare at his eyes the entire time)
Me: "/sigh Alright, this is taking a while, do you want to keep bashing me or do you have anything at all useful/constructive to say?"
Attending: "HOW DARE YOU SAY THAT TO ME!!" (so loud people in hallways heard)
Me: /shrug shoulders, not a word, maintained strong eye contact, not breaking contact
Attending: (can't think of anything else to say, there's literally 2 minutes of trying to stare each other down, then finally:
Attending: "Thank you." (his way of say "GTFO of my office")
But stuff like this is still tough and emotionally taxing, I would still break down after interactions like above. The entire group of residents disliked the program director so much that one desk had an "Eye of Sauron" picture hanging on the wall with the words "Beatings will continue until morale improves". But due to my prior experiences as a abused medical student, I would lay the smackdown on junior residents who would intimidate younger ones with emails starting with "I'm a high-ranking PGY-2 now, and you're a PGY-1 maggot, and your work ethic is unacceptable and blah blah blah <insert bullying bs here>". I hate people abusing so-called rank like that. PGY-2 is nothing. Even "Attending" carries weight to a limited extent.
1st fellowship: No.
I had made it into that one particularly famous Boston institution. Although there are certainly huge egos there, the conflicts are about different things, and not about putting others down or treating people like animals. The pressure to deliver was great, but it was by far a positive experience.
2nd fellowship: Yes.
This was at the same institution as my 1st fellowship, but emotions were for different reasons. It happened at the end of my training, saying farewell to friends and mentors, who cared about me and made a difference in my training. Vastly different from what I went through during medical school and residency. These guys are the ones chairing or sitting in on national level committee meetings and contribute to pushing medicine forward. The attendings involved in the above interactions during my residency are no longer there.
Attending: No.
Now, I wanted to this part in, because this topic of "
work/school making one cry" never stops. It does not stop after medical school, residency, or fellowship. In some respects, the issues mentioned above about dysfunctional personalities, competition, and dragging people down are still there, but in very subtle ways. It's very political and not in-your-face. One can argue this is worse because nobody is telling you that something is wrong. And when it hits the fan, it's your name on the line. But overall, much of all this is not limited to medicine/healthcare. If you look at industry, you see much of the same stuff going on, plus with much higher rates of being laid off or fired. People are still getting dehumanized out there. People get yelled at all the time. Donald Rumsfeld is notorious for inappropriately raking his generals over the coals when unhappy. Build up that mental/emotional teflon; and don't stoop down to their level. I use my prior experiences as a strength - I've built up better rapport with my trainees than other attendings. I've also learned from being the target of abuse/deception, etc., and over the years it's become much harder to bs me. I'm not quite at the level of microexpression master, but you kinda get what I mean.
So the takeaways:
- Even if you fail boards or don't match at your #1 program or don't match at all, don't let those things dictate your own future. You still have a lot of power to change things to your liking. It happened to me, a couple of my classmates I mentioned above, and even some extremely well-regarded attendings at Harvard.
- There will always be dysfunctional people, whether in medicine or industry (probably more in industry) - you must learn how to deal with them, no way getting around it. But do it in a professional manner. Their behavior is usually noticed by people above, and if they treat people like that, just imagine how they will treat patients and colleagues. If they are the ones who actually sabotage people the way described in earlier posts, and continue to do that in their careers, perhaps one day they'll cross the line, and get their state license stripped away. Every month/quarter, every state's medical board publishes a list of people that are getting their licenses revoked or suspended, and it gives a short description why. Now THAT is a list to be ashamed of being on.
- Thus, maintain your integrity. Your patients are counting on your for that.
- Past "failures" are not really failures. View them as lessons, and learn from them.
- Feeling worried/anxious about all this stuff is normal. We are human. I'd be worried if you weren't anxious at all!
Hope that helps. Back to my papers. Damn, didn't know it would end up this long.
