Veering away from the predetermined path of training in medicine


With the advent of GPS, the need for self-directed navigation has all but vanished. We find ourselves at the mercy of and indebted to the wisdom of our devices. Occasionally given choices for route preference based on directness, speed limits, or tolls, we are otherwise taken on a course of someone else’s choosing. Agreeable for the ease, wisdom of insight, recommendation based on past experience, we accept the route and follow the directions.

There are times in the midpoint of travel we look around and notice this isn’t the way we expected to go. New roads and unexpected turns. Occasionally we will challenge the recommendation and default to our own past experience to guide us. Many times, we question the recommendation but carry on, convinced the device knows something we do not or cannot.

This can result in an earlier-than-expected arrival time, mapping out efficiency over-familiarity. The unexpected path might introduce us to new lands we might not otherwise have discovered.  Allowing us to operate on autopilot, there is ease to be found in the reduced need for decision making granted by predetermined directions. As with most things in life, however, there are trade-offs to consider.

Operating under the influence of external directives weakens our capacity to navigate on our own. This is true of exploring uncharted territory and of wandering the lands with which we were once familiar. As with any muscle, there is atrophy with disuse, and our strength of navigation diminishes rapidly when we simply follow directions without question or intentionality.

The path of training in medicine is largely predetermined.  There is a defined route of matriculation. From the expected high performance beginning in pre-college days to required classes and test scores, the preamble to medical school is written in advance. The courses, rotations, evaluations, auditions, and interviews usher the process along. Residency and fellowship have rigorous requirements that require focus and cooperation with the course as scripted. Most paths to practice are paved, and the destination decided before arrival.

Upon reaching the stop of attending physician, there is the combined sentiment of relief, pride, excitement, and confusion.  Queries of “now what” and “is this where I’ve been heading all this time” emerge alongside a sense of insecurity around further decision making. While the years of training condition excellence and capacity in the direction of a specific goal, they can wield weakness and timidity in other areas.

Having relied on external directions for more than a decade, the capacity to engage one’s own inner guide can be challenging. While the course may have been the most efficient available and have introduced lands not otherwise discovered, arrival on autopilot can be disconcerting.

A sense of insecurity around decision-making emerges. Muscles of directional intuition and awareness are weakened by years of disuse.  Disconnected from our internal compass, it can be challenging to recognize our true north. This leads to wondering and wandering and can result in feeling stuck. Unsure of next steps and deconditioned in the paving of paths, staying becomes the default.

Staying on its own is not a problem. Staying out of choice can be secure. Staying out of resignation can feel confining. Staying because leaving seems impossible can be an inescapable trap.

Beginning to exercise the muscles of navigation is like any new workout – leaving us feeling awkward and sore. Also, as with training, proficiency comes with time, repetition, attention to technique, and consistency. Starting with smaller ventures, independence is nurtured by traversing familiar terrain without external references. Identifying reliable landmarks and recreating guideposts comes with practice. Stepping into unknown territory in small doses starts to build confidence and capacity. Trusting oneself to remember the way home develops first. Reliance to venture toward destinations unknown can follow.

The trade-off for renouncing the ease that can be found in the reduced need for decision making granted by predetermined directions is expanded opportunity.  Opening horizons and perspectives allows for unlimited potential. Daunting, perhaps, but with strengthened self-reliance, the unknown becomes manageable, and excitement outpaces confusion.

The paved paths and assistive devices remain ever available and can serve as supportive resources, leading efficiently to amazing destinations. Embracing them knowingly, willingly, and with the awareness that it is possible to step forth independent of them is an entirely different experience than relentless reliance.

Opportunity exists to selectively choose when to opt-in. To release the decision making and appreciate having an external source of direction can be freeing. Paying attention to the surroundings along the way can empower the possibility to participate at will. Opting out from time to time to explore from our own perspective, strengthens resourcefulness for future endeavors.

Cultivating core values, outcomes, and potential creates reliable guideposts. Mapping from a place of knowing, while embracing not knowing, establishes a dependable true north. Being a willing participant in all versions of the journey is always an option.

There are certainly non-traditional routes available, and it is encouraging to witness new trails being blazed at all stages of the process. Learning from those who rarely seek external frameworks can be inspiring. Observing navigational skills and the self-reliance that supports them offers the wisdom of insight to lead the way. May we see the opportunity to integrate all available resources while trusting ourselves to be our own greatest guide.

Amelia L. Bueche is an osteopathic physician and founder, This Osteopathic Life.

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