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Perfection: A Non-Existent Finished Line

Medical students are driven. It is in our nature. To earn acceptance into medical school, we have strived for good grades, holed up in the library preparing for the Medical College Acceptance Test (MCAT), participated in community service, led clubs and extracurriculars, and more. We all have a unique story behind our medical journey, but every single medical student has worked incredibly hard. In doing so, however, most medical students have spent their lives striving for and expecting perfection: zero flaws.

I have always loved learning simply for learning’s sake with a focus not on a numeric grade but the goal of seeking a fuller picture of our world. Despite my natural inclination toward the sciences, I was (and quite frankly, still am) incredibly fond of other subjects, including history. There is something beautiful about understanding our origins and development, both on the molecular level as we see in the sciences and at the larger societal level.

Nevertheless, thinking back to high school, I spent days and days in lunchtime office hours with teachers to squeak from that seemingly trivial difference of B+ to A-. In college, I reviewed exams with professors to make sure that I did not make the same mistakes again. And of course, this is not necessarily a bad thing; being driven is what pushes so many of us to persevere on this challenging path. We love to learn, and the opportunity to achieve a lifelong rewarding career in medicine is dependent on the work we put in now and moving forward.

Improvement is at the core of who physicians are. If we do not strive to be better versions of ourselves, then we are doing a disservice to our patients who deserve good care. However, in order for medical students and physicians to pursue such a lifelong career of learning, we need to decidedly put aside this idea that we can ever be “perfect.” Medical professionals can never be, as Merriam-Webster defines the word, “entirely without fault or defect.”

After all, Lester Liao reminds us that physicians are first and foremost human. Expecting physicians to be anything more counteracts the mentality that physicians should be lifelong learners and strive for perpetual improvement. Liao references five ways in which humanity can be acknowledged in practice. First, humans and patients have shared experiences by nature of their common humanity. The second is that people cannot have their personal and professional lives separated entirely. Third, physicians think and have real human emotions. Fourth, physicians are fallible and finite — they do make mistakes and cannot be everywhere or do everything. Lastly, physicians are moral beings who want to promote the health of their patients. Of the five tenants, the fourth is likely the hardest for future physicians (and even current physicians) to internalize.

Striving to be the best we can be is in itself not the problem. We should always be seeking to have patient encounters that are positive. But each patient is different, and each encounter is different; no two situations will be exactly alike in our careers. So with more experience and wisdom, we certainly become better physicians, but nothing can fully prepare someone for every possible scenario. In this way, we are inherently fallible and finite. Liao emphasizes that it all comes down to remembering our humanity — keeping in mind that we are at the end of the day humans like our patients.

If our healthcare system begins to intentionally promote personal growth across the spectrum from administration to trainees, the culture of medical education will be grounded in how finite we as humans are. For example, he says that when criticizing, it is important to provide solutions for how to make the patient encounter or procedure better the next time. Simple critique without solutions can lead to a physician or student becoming burnt out or feeling like there is nothing they can do to be good enough. And this applies to physicians as well as students. Productive conversation in which we acknowledge what went well and where growth is still possible will harbor the sought after improvement.

Far too often, it is easy to get caught up in wanting to be seen as a figure who knows all; it is easy to be afraid of being vulnerable or not seen as the know-all in a field. Teachers should use their past learning experience and help students to see that their mistakes are part of the learning process. Where have they gone wrong in their careers with patients that the student can learn from? With each procedure or patient visit, we will be able to reflect on the most recent experience as a springboard from which to make the next better — not as an isolated encounter to perfection.

This of course can be challenging. Like I said, what makes medical students medical students in the first place is a driven personality and quest to be great. However, with many medical schools transitioning to a pass/fail system, particularly in the preclinical years, students can begin to transition their mindset from learning for a grade to learning for themselves, or better yet, their future patients. While challenging to switch such a mindset when all of our lives we have tried to get straight As, this shift might permit our actions to have greater intention and the ability to evolve.

Instead of looking at learning biochemistry as a means to an end, look at it from how this can be useful in practice. Then once we are in the clinics, that knowledge can be expanded without feeling like we are failures for not knowing it from the start. Not to mention that medical students by nature are all going to be doctors. By working hard, we will each achieve that goal; while many pre-med environments can be competitive, there is no need for that to continue.

As a first-year student, I am fortunate to be participating in a curriculum which encourages physicians to be ever-evolving and improving. In addition to completing science coursework, medical students at my school participate in a longitudinal course that spans across the first and second years that focuses on connecting with patients and becoming more holistic clinicians. Starting with the first standardized patient encounter we completed, the course has emphasized a growth mindset; instead of focusing on one isolated grade or performance, we focus on how we can make every subsequent interaction better than the last. In my second patient encounter, in particular, we interviewed a standardized patient and took a patient history. Afterward, we practiced writing that patient’s history in a way which effectively communicated results to healthcare professionals of all backgrounds. After conducting the patient interview, our facilitators (one for every 12 to 13 students) provided feedback as to which elements of the patient interview we performed well and specific areas in which we could improve.

My facilitator, a physician herself, explained the reasoning for performing so many practice patient encounters: we shouldn’t enter school expecting to take a patient’s history perfectly, but we must channel our passion for people and love of medicine to continue to practice and strive for constant improvement. She says that when having these encounters, what she tells herself (and us) is that we are human. It is in our nature to connect with humans; we are just doing so in a specific way that will help to target their particular needs. With this in mind, I have noticed that students take feedback much more openly than if we were just given a list of places we went wrong. I remember that I will have more opportunities to better employ these tools that are now in my toolbox.

If we maintain this notion that we “should” be at an endpoint or finish line of flawlessness, then we are just running a sprint to a specified but non-existent destination. Medicine is a marathon, though, not a sprint. We cannot believe that our journey to becoming a physician ends with graduation. While staying up-to-date on scientific literature throughout our careers will certainly be important, striving for continuous personal growth will serve us as both professionals and, more importantly, as humans.

Jennifer Geller Jennifer Geller (7 Posts)

Contributing Writer and Editor in Chief Emeritus

Rutgers Robert Wood Johnson Medical School

Jennifer is a fourth-year medical student at Rutgers Robert Wood Johnson Medical School in Piscataway, New Jersey class of 2024. In 2020, she graduated from Brandeis University with a Bachelor of Science in chemistry and biology. When not studying medicine, she enjoys skiing, baking, and spending time with friends and family. Additional academic interests include medical education, narrative medicine, and bioethics. Upon graduation, Jennifer hopes to pursue general surgery residency.