Students & Residents

Arrival Fallacy in Medical Education and the Pursuit of Happiness

For the past couple of years, I’ve been struggling with a phenomenon known as arrival fallacy, which has been described as the “illusion that once we make it, once we attain our goal or reach our destination, we will reach lasting happiness."¹

Caroline Cassidy, Central Michigan University College of Medicine, Class of 2026

I have noticed this term applies particularly well to the medical profession where, most of the time, the light at the end of the tunnel seems so far out of reach. I thought that I would feel this huge sense of accomplishment if I was accepted into medical school, but instead, I have the anxious feeling that I will not be good enough until I have accomplished everything else, too. I started to wonder why I can’t seem to give myself credit for reaching all my goals thus far.

Growing up, whenever I said I wanted to become a doctor, I remember mumbles from family, friends, teachers, and advisors of, “You know, that’s a lot of school,” with the insinuation that I should consider an easier path. I always loved school and learning, so I thought I was prepared. However, when I started medical school, in 2022, I realized it wasn’t just “school”, but everything else that is expected of medical students, that was going to make this journey a particular challenge. Generally, this education pathway consists of four years of undergraduate education, four years of medical school, 3-7 years of residency in your desired specialty, and possibly, at least one year of fellowship training if sub-specializing. That can add up to well over 10 years of training.

Aside from doing well in my courses and standing out in standardized exams, to become a competitive residency applicant, we are encouraged to take on leadership roles, participate in community service, publish research, network in our desired specialty, become good teachers, keep up with emerging medical literature, and find time to sleep, while still maintaining our hobbies and relationships with loved ones. Medical students have indicated that they are burdened by exorbitant tuition and fees with debt entering hundreds of thousands of dollars.2,3 Third-year medical students dedicate many of their waking hours to hospitals and clinics, with extraordinarily long work weeks and shifts. Stress, exhaustion, and burnout are the norm for some, and 24-hour shifts are viewed as a badge of honor. Under constant evaluation, I feel like I need to be the perfect medical student: confident, but not cocky; enthusiastic, but not fake; smart, but not a know-it-all; ask questions, but don’t be annoying.

We will likely spend most of our fourth year applying to and interviewing at residency programs across the country to participate in a sorority-style “Match” process in the spring. We run the risk of getting to Match Week and learning that none of the programs we ranked chose us too, so we’ll have to enter the Supplemental Offer and Acceptance (SOAP) process or try again the next year. This idea looms over my head like a storm cloud and explains why every time I accomplish something great by conventional standards, I start looking to surmount the next goal, forgetting to even pat myself on the back for how far I have come.

I have spent a lot of time during the first two years of medical school wondering how I can be better at living in the present instead of always looking for the next hurdle. I can’t simply wait to “reach lasting happiness,” until I am established in my career. For me, and many other students, we could be in our 30s or 40s, having dedicated more than a decade toward the pursuit of medical knowledge. I recently read an article about the downfalls of the phrase, “I’ll be happy when,” which explains how happiness is broad and complicated, but that joy is simple.4 Once I began looking for the little things that sparked joy, my days became easier and more fulfilling.  Finding joy in everyday moments such as my first cup of coffee, dinner with friends, a walk after breakfast, farmers market flowers, a phone call with loved ones, or a movie and popcorn before bed, is much more attainable than the daunting idea that I will be happy once I match into my dream residency program. I would encourage all medical and pre-medical students to try incorporating this subtle switch from correlating happiness with accompanying goals to searching for joy, instead.

Changing my thought process has really helped me live each day in the present. I love being a medical student and I am so excited for what the future has to offer, but I can always use an extra reminder to not tarnish the present by living in the future.

Caroline Cassidy is a soon-to-be M3 student at Central Michigan University College of Medicine. She enjoys learning about our current medical education system and finding new ways to support medical student and trainee mental health.  

References

  1. Shilton, A. C. You Accomplished Something Great. So Now What?. The New York Times. May 28, 2019. https://www.nytimes.com/2019/05/28/smarter-living/you-accomplished-something-great-so-now-what.html
  2. Rohlfing J, Navarro R, Maniya OZ, Hughes BD, Rogalsky DK. Medical student debt and major life choices other than specialty. Med Educ Online. 2014;19:25603. Published 2014 Nov 11. doi:10.3402/meo.v19.25603
  3. AAMC. Medical Student Education: Debt, Costs, and Loan Repayment Fact Card for the Class of 2023.; 2023. https://students-residents.aamc.org/media/12846/download
  4. TED. Why You Should Stop Saying “I’ll Be Happy When”. TED Ideas. https://ideas.ted.com/why-you-should-stop-saying-ill-be-happy-when/. Accessed March 8, 2024.
Disclaimer:

The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.