The gunner culture hurts the future of medicine

As graduation nears, I recall an away rotation that concerns me for the future of medicine. I remember eagerly boarding my plane, ready to work hard, learn as much as possible, and explore the unknown. My first day in clinic, I was excited to befriend the student I would rotate with. After seeing our first patient together, she asked me to share my clinical reasoning for the case. I happily taught her about the diseases on my differential. When the attending physician joined us and asked for our thoughts about the patient’s case, my peer blurted out everything that I had just taught her, claiming the ideas as her own. I had heard of these students before: the infamous “gunners.” My heart sank.

As the week progressed, my fears were confirmed. When I was asked questions, a second voice would inevitably echo my answers. Differential diagnoses were volunteered on my patients. Once, an attending encouraged me to investigate a question that I asked about my patient only for us to return from my patient’s room to my peer’s monologue about a paper that she had found to answer it.

There is an unwritten rule among medical students. As comrades, we credit each other, and we don’t step on each other’s toes in patient care. It became clear that my goal for the month was no longer to thrive, but to survive.

I could play this student’s game back, or I could stay true to myself. I chose the latter. My peer focused her energy on interrupting questions of us to be the first one to answer, striving to be heard and seen at every possibility. When walking with our team, I could predictably watch her walk in front of me in order to cut me off. Patient encounters became a tool with which she tried to be perceived as “helpful.” She would race to turn on light switches, elbow me aside to pick up requested supplies, and scurry between a trashcan and procedure tray with one piece of trash at a time in order to ensure that I was forced to the sidelines. Meanwhile, I put my head down and worked hard, spent rewarding hours with my patients, and learned as much as I could about their diseases.

My rotation did not go as planned. I traveled a long way intending to exchange ideas and work as a team to care for patients in a new environment, but I felt out of place. It was utterly discouraging, and I wondered if I had made a mistake in rotating at one of the best hospitals in the country.

The patients and doctors there kept me going. The amazing medicine constantly reminded of why I was there in the first place. I want to use my love of problem-solving and learning in order to help people at their most vulnerable. Nobody could take that motivation away from me. But with this realization, a greater sense of responsibility than ever to speak up about “gunning” remains.

Students like my peer make others look bad in order to make themselves look good, rather than striving to strengthen the team. This has dangerous implications for patient care. What plagues me above all is that these students use patients for their own means. They walk into a room looking to use that encounter to check career boxes. A patient with terrible, life-altering wounds becomes a prime opportunity to pull dressings begging to be needed out of a white coat. Exam findings are ogled in order to demonstrate exaggerated enthusiasm. Questions about a patient’s care become low-hanging fruit for students to trample their peers in an attempt to be the first one to utter the answer, with no concern for what that answer means for the patient in front of them. You can race to read a bottle at the bedside to answer a question regarding its contents, but do you ever pause to reflect on the patient’s suffering that warranted those treatments? What is your ability to read the label first really doing for them?

We have a duty to call attention to behavior that if left unchecked could translate into bad patient outcomes. Our workplace culture brushes “gunning” under the rug. For the sake of professionalism, my only consolation was confiding in my classmates back home. Their tongue-in-cheek reminder to wear Kevlar under my white coat encouraged me to get the most out of a challenging situation without changing who I am. But who will protect patients from the stray bullets that will inevitably hurt them when we produce physicians who are rewarded for petty behavior as medical students?

Medicine will always foster competition; the competitive drive of the human race has helped us to achieve amazing things. Cures for diseases and treatments that alter disease prognosis and improve quality of life were developed because of our intrinsic drive to be our best. But with the heavy demands placed on health care providers constantly pressed for time, it is more important than ever to cooperate if we want to make the difference in people’s lives that we hoped to make when starting medical school. We are all batting for the same team, but the pressures that students face can make them lose sight of this reality. Wonderful people enter medical school motivated to make the world a better place only to succumb to stress. They may leave with an MD, but at the cost of who they were before a profession — and its rubrics they have allowed to redefine success — became their sole identity.

Challenging as it was, I loved my away rotation. I worked with powerfully motivating role models, learned about complex pathology, and had the privilege of caring for patients that I will carry with me forever. I urge us all to constantly ask whether our actions uphold the most important goals of all: to do what is best for the patient, and to do no harm. We students are the future of medicine.

Kelsie Riemenschneider is a medical student.

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