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Is Competition Important in Medical School?

June 16, 2008

Question

How important is competition among medical students? How do we train our minds to strive for absolute excellence rather than a relative one?

Response from Lisa Jacobson, MD
Resident, Emergency Medicine, Mount Sinai School of Medicine, New York, New York

It’s hard to imagine academic life as we know it without competition. Our society has created an environment where, in order to move on to the next phase, you must not only succeed in the current phase, but also succeed more than others in the same situation. Some high school students hire tutors for college entrance exams in order to get into a top college. Then they fight for every last point on their organic chemistry exams to make themselves more attractive candidates for medical school. During medical school, they do whatever it takes to graduate with honors, improving their chances of matching in their specialty of choice. Perhaps they continue to compete with their colleagues while in practice, hoping to develop the most lucrative and successful practice possible.

Or am I just cynical? Are there students out there who learn for the joy of it?

It may not really matter. The real issue is whether you will be a better physician if you, as the question phrases it, strive for “absolute excellence” rather than a relative one.

Many experts have addressed this and related questions in the education literature, but they have never reached a consensus. Modern adult education theories strive to explain how and why adults learn. One theory, andragogy, operates on the assumption that adult learners are internally motivated, as opposed to the external motivations of childhood. It assumes that adults are capable of self-directed learning, are internally motivated, and will not learn until they have a rationale to do so. Others refute that, believing that secondary gain and external incentives still play a large role. Medical students likely have a combination of internal and external factors influencing them, with each person representing a different point on the spectrum.

Medical educators and administrators have been addressing this question for decades. Many universities have abandoned the classical A-F grade paradigm for a pass-fail system. The most common explanation for this change is to reduce the competition among students and engender a safer, more pleasant learning environment. Rather than spending time comparing themselves to others, students can instead make self-reflective evaluations of whether they have mastered the material. The few studies that have formally evaluated this difference in style have not reliably proven, or even suggested, any difference in the quality of physician produced.

Some people believe that in a pass/fail system there is no competition and you can therefore develop into a life-long learner who enjoys the process, but I am not sure that this is always true. There will be students in both systems who learn just enough to get by, whether it is just enough to pass or just enough to get the lowest A. No one denies that these students exist right alongside the students who study to learn regardless of the grading paradigm.

Finally, I wonder whether scores and grades truly correspond to success as a physician. Do we have any proof that the honor society, published intern will make a better physician than the middle-of-the pack intern? In fact, studies attempting to answer this question have suggested that there is no correlation between grades in medical school and success as a physician. Researchers have found that college grades and scores on the MCAT indicate success in the preclinical years of medical school and on the US Medical Licensing Exam (USMLE), but these are not truly the endpoints of import. Studies have not reliably found purely academic predictors of clinical success.

Each student learns differently. Perhaps the best answer to the proposed question is personal: If you have always learned best under pressure or competition, then seek out that environment — it definitely exists. If, on the other hand, competition does not motivate you, or you generally learn simply for the joy of learning, you should pursue a different environment. No matter where you lie on the spectrum, you can use your self-motivation as an adult learner to find an appropriate learning environment, allowing you to become the best physician you can be.

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2 Comments leave one →
  1. June 18, 2008 1:00 am

    Mors tua vita mea 😦

  2. June 18, 2008 7:19 am

    Thanks for that phrase Alberto. I had to search for the meaning. Here it is:
    The term Latin origin of medieval Mors mea your life, literally translated, it means your death is my life.

    Beyond the literal sense that sounds dramatic, this phrase is used when in a race or in an attempt to reach a goal there will be only one winner.
    Mors your life mea” means in essence that your defeat is tantamount to my victory, and then me hope without remorse.

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