Transition to Residency and Beyond (with kindness)
Jeremy J. Kudrna
University of South Dakota, Sanford School of Medicine – MD Class of 2020
Penn State College of Medicine, Department of Ophthalmology – Resident Class of 2024
“Are you satisfied with your scores*?”
* MCAT for pre-medical students
* USMLE exams for medical students
* Press GaneyTM surveys for residents and attendings
This question tends to cause distress for many of us. But the intention of this article is not to cause distress nor to provide bullet-proof science defending a thesis. It is simply an optimistic op-ed, from the perspective of a grateful M4, who is eager to transition to residency.
Certainly, scores are omnipresent starting well before medical school matriculation and persisting through the transition to residency (and beyond). However, based upon my experiences, how these scores are used can pollute the journey and negatively affect learner well-being and resilience.
There’s no sense denying traditional axioms:
- Objective data helps to ensure standards.
- Numeric scores are quickly comparable equalizers.
- Multiple-choice tests are validated assessments.
Despite an appreciation for these well-intentioned notions, issues for learners, providers, and patients arise when scores are viewed as the end-all-be-all. Learners become paralyzed with imposter syndrome – comparing less than stellar scores with others’ seemingly perfect ones. Providers become checkmated into focusing on patient satisfaction scores over applying their training appropriately. Patients become mislead when seeking the “best” care. While I do not believe there is a deliberate intent for scores to harm, placing too much stock in scores does a disservice to key stakeholders.
Ultimately, there is a paucity of evidence to support scores as the end-all-be-all for evaluating pre-medical students, medical students, or physicians. Convenient, sure. But sufficient? Hardly. Nevertheless, de-polluting the score-obsessed transition to residency journey is possible and currently happening. One monumental, recent example is the changing of USMLE STEP 1 from a numeric score to pass/fail. Other examples arose from recurrent conversations I enjoyed having with colleagues across the country during residency interviews.
Deeper realities to medical students’ transition to residency became apparent:
- “Gut feelings,” oftentimes shape applicants’ Rank Order List.
- We are all imperfect humans, not perfect-score-making AI machines.
- Our vulnerability, not our superiority, connects us with patients’ suffering.
As a future ophthalmologist, 2020 is special year to graduate medical school. Perhaps there are many visions, goals, or dreams you wish to bring into the light this year – for others to see with your same 20/20 vision. My 20/20 vision revolves around kindness.
What is kindness? Kindness is a self-evident virtue. It is simultaneously an intangible human feeling and conveyed in tangibly memorable ways. All of us know when we have been treated kindly or unkindly. Kindness is not a score. Kindness is what we do and how we do it – a way of life, for life.
There are tangible steps that medical communities can make to play their part in promoting kindness. One example comes from my soon-to-be (!) alma mater – University of South Dakota Sanford School of Medicine (SSOM). Through “The Kindness Project,” SSOM emphasizes a culture of kindness intentionally across all four years: white coat ceremony, bioethics courses, a professionalism paper, a Healer’s Art Seminar, various electives (humanities, professionalism, spirituality, cultural immersion), and student/faculty performance evaluations that highlight kindness alongside technical competencies. Scores occur but do not define; how we will be remembered is not scores but how we treated others. People do not care what you know, until they know that you care.
As pre-medical students, medical students, residents, and attendings, we understand there is much more to the career path in medicine than multiple choice examinations and soliciting perfect patient satisfaction ratings. It is a journey enriched with influential people and special opportunities to touch others’ lives.
My 20/20 vision for 2020 is to transition to residency (and beyond), not burdened by scores, but touched by the uplifting power of kindness.