Virtually every med school hopeful writes a personal statement with some variation of “I want to help people.” Three years into medical school, helping people seems to be the last thing on any medical students’ mind. At every stage of medical training, there seems to be a competition designed to consume us. Just getting into medical school can feel like an obstacle course with barriers at every step. First-year medical students are quickly socialized into a culture in which USMLE Step scores and honors are the currency, and prestigious residency programs are the goal.
Our sense of self-worth becomes inextricably bound up to “objective measures of performance.” A classmate of mine captured the essence of this when she said, “After Step 1, I feel like I’ll just become a score.” All the tropes about compassion and altruism fade away, and that score is all that remains. Residency programs won’t consider how often I smile or how well I get to know my patients; they will look at the quantifiable metrics that, for them, define my medical student career. In that environment, it is easy to start valuing ourselves the way residency programs value us. Scoring high makes us feel good about ourselves and scoring low makes us feel bad about ourselves. Developing meaningful relationships with patients is tertiary to impressing residents and the attending; after all, patients do not fill out evaluations.
Our identity and self-esteem become bound up in our performance on multiple choice questions, as if those outcomes reflect a deep truth about who we are. They do not. At their best, multiple choice exams reflect the breadth and depth of our medical knowledge. At their worst, they reflect test-taking skill and what we happened to have for breakfast that morning. Multiple choice exams are simply incapable of judging the complex array of skills that make a great physician, much less a great person. This is no fault of the exams themselves, instead, it is a problem in the way we interpret and value the exam results. While we recognize that residency programs rely heavily on exam scores, we must not let their valuation of us seep into our own sense of self-worth. Residency programs may look at us and see only test scores and a transcript, but we must always know that test scores and grades are only a tiny fraction of who we are.
Self-evaluation can help us achieve a more holistic appreciation for our experiences in medical training:
At the end of each rotation, before receiving your evaluations and grade for that rotation, spend some time thinking about how you would grade yourself. Think about the criteria that are most important to you and how you performed in those areas. Here are some suggestions for criteria to use for self-evaluation:
- Did I contribute positively to the care of my patients?
- Did I develop meaningful relationships with my patients?
- How did I balance between academic and personal responsibilities?
- In what ways did I grow as a student? Clinician? Person?
As long as we are honest with ourselves, we are in a much better position to judge our performance than faculty, if for no other reason than because we have much more data. This is not meant to be a feel-good exercise in self-congratulations. It is meant to be a serious way of self-reflection that allows you to honestly evaluate yourself based on your own values.
Having done this throughout my medical school experiences, I have found that my own self-evaluation is fairly independent of my formal school evaluation; the two evaluations agree about just as often as they disagree. This self-evaluation is not intended to undermine or discredit the formal evaluation process; getting feedback from more experienced physicians is critical to our professional growth since they may see things about us that we don’t see ourselves and they may have greater insight into what it means to be a physician. If done honestly and with a healthy dose of self-awareness, self-evaluations can keep us grounded in what matters most to us and offer an important alternative to the narrower, test-focused formal evaluation.
Asaad Traina and Devvrat Malhotra are medical students.
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