Shortly after starting medical school, I found myself feeling a bit down, or as my wife would say, “in a funk.” Don’t get me wrong. I was more than excited to finally be pursuing my dream of becoming a doctor and practice medicine, but something was off. I couldn’t put my finger on it until one day, while walking back to my apartment, I ran into a friend who told me he was feeling the same way. As we walked, talked, and listened to each other’s frustrations, we came to the same conclusion.  The reason we were both feeling a little unfulfilled: our lives were currently all about us. 

It was an easy trap to fall into. In those crucial first few months of medical school, failing a test or course was constantly at the back of my mind. The fire hose of information had been turned on and it was all I could do to keep up. The thought of doing anything extra wasn’t even on my radar. Eventually, I acclimated to the chaotic pace of medical school and many of the worries and fears dissipated as I found my groove and learned to enjoy the challenges of the rigorous pace. Although the fear of failing was still present, it lessened as I learned to surround myself with Givers. 

Students pursue medicine because they care about others and want to help

Up until I started medical school, service had been an important part of my life. I was raised by parents who encouraged me to look around and see what I could do for others. For my Eagle Scout project, I fundraised money to buy special cleft palate bottles and other needed supplies to send to an orphanage in China. My dad always made sure my brothers and I shoveled the walks and driveways of our elderly neighbors after snowstorms in the winter.

When I graduated high school, I left home for two years to live in France and serve a mission for The Church of Jesus Christ of Latter-Day Saints. Not everyone wanted to hear a gospel message, but I found that many people needed help in one way or another. Dedicating two years looking for ways to serve others enriched my life and broadened my perspective. We share more in common than we have differences when we take time to get to know our neighbors.

In college, I met my wife, who is a special education teacher. I loved volunteering in her classroom where the needs of the students seemed to be endless. I helped kids with everything from reading and math to science fair and art projects. We started an early morning basketball club for kids whose parents couldn’t afford to sign them up for the county recreation league. I had as much fun playing basketball as the kids did. I mentored two teenage brothers in the foster care system and took our dog to visit patients in the hospital. Life was good and it was satisfying, feeling like I was making a difference in my community. I have always known that I wanted to make a career out of helping people and medicine seemed like a natural path. 

I have noticed that many of my fellow peers had similar experiences prior to medical school that solidified a desire to enter the healthcare field. Without these experiences, it would be impossible to see the light at the end of the long daunting tunnel that is four years of medical school. These opportunities to reach outside of ourselves remind us of the importance of our future roles and keep us motivated when the light fades and we start to wonder why we began this journey in the first place.

Medical school shifts the priority to studying and passing boards over service

In medical school and residency, the lamentable truth is that grades matter. You could be Mother Teresa, but if you flounder on Step 1, you’ve unfortunately closed a lot of doors to your future options. Moving to a pass/fail system will partially remedy this, but applicants will still need to be differentiated. Step 2/Level 2 scores, in conjunction with class rank and research publications, will become the main considerations for program directors looking to sort the thousands of applicants competing for a dozen spots in their program. 

Just look at the most recent 2018 NMRP Program Director Survey. In selecting applicants to interview, the primary factor stated by 94% of all program directors was Step 1/Level 1 scores. Only 54% of program directors cited volunteer work and extracurricular activities as important. It is no wonder that medical students spend significantly more time studying for their exams and boards than they spend looking for and participating in meaningful service opportunities.

I do scratch my head in wonder sometimes at the fact that a program can place so much importance on a score that is almost two years old at the time of applications and emphasizes material that a majority of doctors readily admit is useless in day-to-day practice. As a third-year medical student, I never once had an attending quiz me on the steps of the Krebs Cycle. Fortunately, more and more programs are placing a greater emphasis on the “whole applicant” rather than just a three-digit board score.

Givers and Takers: Which one are you?

I recently watched an amazing TedTalk by Adam Grant. The talk was so inspiring that I immediately bought his book and read it. Adam Grant divides people into Givers and Takers. We have all been involved in those group projects where someone does not pull their weight but still gets the credit of a job well done. If this experience doesn’t resonate with you, you just may be a Taker. Givers, on the other hand, are those who silently pick up the slack from the Takers. A Giver doesn’t always receive the credit for a job well done, but that doesn’t bother them. Their focus is on making sure the group is successful. As in life, medical school is full of both Givers and Takers. 

Givers are those who go into situations focusing on what they can do for others. Takers, on the other hand, look for what others can do for them. It is often difficult to recognize a Taker at first. They can be charismatic and outgoing, but eventually their needs have been met and they move on, having gotten whatever they needed from the relationship. Individuals who give, of course, can be just as charismatic and outgoing, but they work to benefit others, even if it means that a promotion, scholarship or award goes to someone else. 

Givers At The Bottom and Givers At The Top

People who give constantly, those who sacrifice themselves for the good of others, consistently finished towards the bottom of their class according to Adam’s research. He summed this up nicely with the following example: You’re at school studying and you notice one of your classmates just isn’t grasping a topic you’ve got down.

Instead of moving forward and learning new material, you pull back and help your classmate learn what you’ve already mastered, sacrificing time you could be using to move on to something new. The classmate could possibly have an advantage over you come test day, but you’re a Giver, so this doesn’t even cross your mind.  

Consider cycling. Lance Armstrong, love him or hate him, would have never won 7 Tours de France without his trusty domestique, George Hincapie by his side. Domestique is a cycling term and identifies a rider whose sole job is to support and sacrifice for the team leader. It is a French word that translates to ‘servant’ in English. Michael Jordan? Probably wouldn’t have won 6 championships without Scottie Pippen and Dennis Rodman on his team. In a way, these Giver athletes sacrificed the spotlight and personal fame for the betterment of their teams. These teams and their stars had tremendous success because of these silent Givers. 

Givers fell to the bottom of their medical student cohort, so it would seem logical that the Takers took the top spots. Surprisingly, Adam Grant’s research found that another set of Givers rose to the top of their class ranks. The reason actually makes a lot of sense. The first two years of medical school are book heavy. This course load tends to favor Takers as they can focus on their own needs without having to look out for those who may be struggling. During the third and fourth years of medical school, students transition to clinical rotations.

Teamwork is rewarded and students who are Givers tend to stand out more and make lasting impressions,  not just with the doctors who evaluate them, but also the nurses, medical assistants, and other team members they interact with on a daily basis. 

Looking back at the 2018 NMRP Program Directors Survey, while Step 1/Level 1 board scores make up the top spot, Letters of Recommendation and the Medical Student Performance Evaluation (MPSE/Dean’s Letter) make up the second and third spots respectively. These evaluations actually favor Givers. While impressive board scores may get your foot in the door, Letters of Recommendation and the MPSE are what seal the deal and get you the residency spot you desire. In this sense, there is real value in being a Giver.

The most successful people in your class are most likely Givers. It’s the Givers who will most likely excel during those coveted audition rotations and land their dream residency spots. Better residencies have the potential to lead to better job and fellowship opportunities and these opportunities will most likely turn into increased earning potential. In a sense, it literally pays to be a Giver.  

Givers are needed now more than ever

Medical school is hard. A quick Google search for ‘burnout in medical school’ comes up with almost 19 million hits. The National Academy of Medicine defines burnout as “a syndrome characterized by high emotional exhaustion, high depersonalization (cynicism), and a low sense of personal accomplishment.” Early on in my first year of medical school, during that walk back to my apartment, my friend and I were already experiencing symptoms of burnout. We weren’t alone, as over 50% of medical students will experience similar symptoms over the course of their education. Take a minute to think about that. Half of your class is struggling with “emotional exhaustion” and “a low sense of personal accomplishment.” Half of your study group is experiencing cynicism. Burnout can affect not just your peers’ school performance but also their physical health. 33% of medical students surveyed by Mayo Clinic researchers admitted to alcohol abuse or dependence. Only 16% of their non-medical peers admitted to the same problem.

I have found that I tend to experience burnout in projects where I’ve been burned (pun intended) by a Taker. I become more cynical. I wall off and turn off my giving nature. I take a “fool me once, shame on you, fool me twice, shame on me” mentality. I focus so much on not getting burned again that I end up helping no one. I become by default, a Taker. 

How to Be a Giver in a Takers World

During my second year of medical school I surrounded myself with Givers. We shared study guides, memory aids, and helped each other overcome our weaknesses. The weekend before a test we would all get together, order a few pizzas and go over the material together. Our review sessions weren’t “high yield,” they were “massive yield.” My mental health skyrocketed. I can’t help but think that there would be a lot less than 50% of medical students suffering from burnout if their classes were made up entirely of Givers. 

It can be frustrating for Givers to see Takers getting ahead and getting recognition when most (if not all) of their success was secondary to a Giver. How do we learn to strike that balance of being a Giver without letting our efforts go unrecognized? It is easier said than done. And I don’t have a clear answer to that yet. Givers are what make our classes great, they are what keep us going and make us successful. We can all think of someone who is naturally a Giver: someone who goes above and beyond to help others without even taking a moment to think about it. Thank them. Appreciate them.  

Don’t shun the Taker in your group, work a little harder to make them feel like part of the team. Give them the opportunity to feel the satisfaction that comes with working in a group. It may seem like a longshot, but I believe that once the Taker starts to identify with the group and feel like they are part of the team, their selfish desires will start to fade as they realize what is good for the team is actually good for them. 

Just as most issues are not simply black or white, the world is not made up of just Givers and just Takers. Giving and taking is a behavior, and behavior can be changed, just like any other behavior. Everyone, even self-identified takers, can benefit from being generous. It is my hope that anyone reading this (especially Givers who are feeling burned out) finds a little inspiration to help those around them. As our education has shifted to a virtual platform, it is even more difficult to spot those who may be in need. Now is an excellent time for all of us to get out of our comfort zone and actively search for those who may need a little extra help.

Ask questions, share helpful study finds, and most importantly, remember why you went into medicine in the first place. Think back to that one experience or patient that inspired you and keeps you going.

With a little bit of effort, we can turn medicine into a true field of Givers.