S7E15: Redefining Success in Medicine

Alizah: All right. So welcome to "Bundle of Hers." Austen is also on this episode with us, our fellow co-host.

Austen: Hello.

Alizah: So with the new school year starting, I feel like it's kind of fall. It's autumnal. I feel like this is kind of a New Year's resolution time, or maybe that's just me.

Austen: No, definitely. It feels like at the beginning of every school year, it's like, "Okay, this is the year I'm going to ace all my tests. I'm going to study. I'm going to live right, exercise." And so I totally get that.

Alizah: Something I wanted to discuss today was the idea of redefining success and how we kind of make these goals for ourselves, and then what it means when we achieve them or when we aspire to achieve them.

And so today we have Jake, who's our guest, and Austen is co-hosting this episode with me. I'm so excited you guys are here.

Austen: I'm excited to be here, but I'm here often. Jake, it's so exciting to have you here with us today.

Jacob: I'm very excited to be here, too.

Alizah: Well, good. So I just think that redefining success is so important, and I think this idea of redefining success more explicitly is empowering and informing your perspective. And I think that's the groundwork to an inner compass that navigates in alignment with your own North Star, right?

What looks true and good for me is obviously going to be very different than what looks true and good for anyone else. And so this internal compass kind of helps determine what success is and ensures that we're heading in a meaningful direction in that way.

And I just think as school starts and as we're doing these new things, there are a lot of external factors, especially I think around this time of the year, given this fun election year. There are a lot of external factors about what success is, and it seems that it's almost synonymous with performance.

But recently, I think there's this push in what success means in a more private and a more personal sense. And something that I kind of wrote down was, "What's the point of getting to the top of the mountain if you don't even like hiking?" That's not success, is it? And I'm curious as to what success looked like for you a year ago versus now.

And it's appropriate to name that any ideas/thoughts expressed in this podcast are not a reflection of our school or our institution, but are solely a reflection of our own intellect and wit.

So, Jake, what did success look like for you a year ago, and what does success look like for you today?

Jacob: Yeah, that's a great question. You touched a little bit on how you think a lot of people are viewing the idea of success as being something that's synonymous with performance, right? And I think that's extremely common when people are going to professional school, especially something like medical school.

And so a year ago today, or a little over a year ago from today, I was doing the traditional application process with taking the MCAT, doing interviews, trying to finish up my undergrad, working, things like that. My idea of success got extremely focused on performance, right? I wanted good grades. I wanted good letters of recommendation. I wanted to do good interviews. And in that, I think . . . I don't think. I know I lost myself a little bit.

And so, throughout my first year of medical school, my goal was to, of course, stay on top of my grades and my coursework, but I wanted to put myself first, my family or my husband second, and school third.

And that's always been something that was really hard for me to do because that feeling of success had been ingrained in me so much that it was score-based, and it was test-based.

In this first year of school, I came to find out that that's not true at all. I needed to be able to put myself first so that my mental health was in a good space for me to do well in school and for me to be there for patients and in healthcare in general, right?

And so, throughout this past year, I really tried to focus on what success looks like for me as a medical student and how I needed to reshape my priorities and reprioritize them so that I could be successful.

Alizah: Yeah. I feel like everybody kind of goes through . . . is it a baptism of fire? Is that fair to say, Austen? Of, "Oh, whoa. This is first year, and what I had set for myself is kind of different." Do you relate to that?

Austen: Yeah, definitely. I think what Jake described is so common amongst medical students. I think everyone is really hardworking and high-achieving. We all have very similar goals, and a lot of us took fairly similar paths to get there. We're taking similar classes and all of that stuff.

And so I think you get to medical school with a very specific idea of what success looks like just because getting to med school was one of those big successes, and you've prepped so much to get there.

When you're in med school, it's easy to think, "Success is going to look the same. I'm going to work hard, and if I work hard, I'll get good grades. And if I get good grades, then I'll feel good about myself, and I'll feel validated, and feel like this is where I'm supposed to be."

And I think it was interesting starting medical school, even when I was doing well, even when I was studying and doing well, that didn't feel like enough to get the same validation that I got in undergrad, if that makes sense.

It was easy to kind of lose myself in all of the studying and kind of forget what my goals were and what I was really trying to accomplish, especially given the context, being surrounded by so many smart, incredible people. It was easy to be like, "Damn, why am I here? What do I have going on that's special? Because everyone else is doing the same thing and they're doing it either better than I am or they're making it look easier than what it feels like for me."

And so I really loved that, Jake, you went into first year knowing, "No. I'm going to reprioritize things. I'm going to redefine success from the get-go," because I think that would have saved me so much struggle and internal conflict in first year.

I feel like I got to a point where I was staying on campus and studying with friends and having a good time, but I was also kind of looking at myself and being like, "Well, what am I outside of this?" and not really having the clarity that I used to have.

And so I like how you took the initiative to really take a step back and be like, "I'm going to focus on what's important." And school is important. Learning is important. This is what's going to be the foundation for our professional careers for the rest of our lives. But also giving yourself time and space to prioritize your own personal growth and comfort and stability is so crucial.

So, yeah, it's been interesting. What about you, Dr. Rooney? What do you think? Also, everyone, I call Alizah "Dr. Rooney" sometimes.

Alizah: Yes.

Austen: Sorry.

Alizah: And I respond to it, most importantly.

I don't know. I felt like first year was this cold plunge almost where . . . Not that I came in and I was thinking I was some big shot. I feel like I definitely came in with a good understanding of we're scraping by and we're happy to be here, and let's hope they don't go back and re-review applications, because I think I might be the first to get cut.

But I do remember, "This is different." Not only do you have to perform academically while your personal life also has to be incredibly stable, or you have to be able to manage it really well. There's no room of, "I stayed out on the weekend all night, and I had a good time, but it doesn't matter because I'm still going to ace my test that week." No. These tests will not pass themselves if you are not sleeping right, if you are not all there. You have to be on your A-game in all aspects.

And so I'm just wondering . . . Austen, it seems like you came in, and you were like, "Whoa, maybe I should have redefined success before." And Jacob, you kind of came in with this, "Something is up here, but I've got to put me number one." I'm wondering when you guys kind of came to that place of, "Something has got to shift."

Austen: For me, it was probably second semester, first year. I was performing academically the way that I wanted to, and that was good, but I still wasn't happy. I didn't feel socially connected to very many people in our class, and I think that was part of it.

And I think going into medical school, it was just some foregone conclusion that I would study all the time and kind of be miserable for four years. And I thought that would mean I made it.

I think based off of what other people had said . . . And I don't think med school has a really good rap of being a happy time of life. I know, hard to believe, but true.

Alizah: Oh my gosh.

Austen: I think everything I'd heard, I'd just been like, "Okay, I'm going to be miserable for four years. I'm going to be working hard. I might have moments of joy, and then at the end of it, I'm going to be a doctor." And so I think that's really how I approached it the first semester.

I still obviously had moments of fun, but I think so much of my energy was absorbed by studying, being a med student, being worried about my grades, being worried about where I was in the internal ranking, and stuff that, at the end of the day, I don't think I really cared about. I mean, obviously, I want to do well so that I can better serve my patients, but it's not like I feel the need to be the top person in the class.

But yeah, I think I just got to second semester, and even though I was achieving these goals and meeting metrics that previously I would have looked and been like, "Wow, I'm being successful," I felt really alone.

And even though it wasn't true, I didn't feel particularly well supported. I think a lot of that had to do with my mental state. I was not in a good place. I was having really dark, scary thoughts. And so I got to a point where I was like, "I don't like where I'm at."

It took being in a bad place, even though on paper maybe it looked like I was in an okay place, for me to be like, "Okay. This is not success. This is not what success is supposed to feel like."

After that, I was able to get connected to some resources through the school of medicine, which was really helpful. And I was more intentional about making connections with classmates because I wanted to feel more integrated in my class. And I saw the value in having friends.

I like having friends. I like being social. And I had been cutting that out because it felt like it was a necessary sacrifice for my misguided preconception of what success was supposed to look like.

Alizah: Jake, really quick, before we get to you, I want to read this study found in the International Journal of Methods in Psychiatry that found that impaired mental health status in the first semester of university study significantly predicted poor academic performance during the overall undergraduate period. Even corrected after the fact, people did not have incredible academic performance even after they found resources and stuff.

Jacob: It's interesting hearing both of you talk about your experiences, because mine has been vastly different. As we've seen across the country, a lot of different medical schools are switching their curriculum style. And I think a lot of it is because they're starting to think about what success means for their students, right?

So we've seen this traditional curriculum where the first two years, you're in lecture, you're studying, you're really in these books for days at a time, and students are losing sleep, and you're required to know so much.

I feel like I kind of lucked out because as the University of Utah has switched my curriculum, I've seen, at least with me and some of my colleagues, a little bit of a shift in the way that medical school is affecting us. It does look slightly different, and they are trying to look out for things like our mental health.

And so I remember for the first six weeks of starting medical school, we did Transition into Medical School, and they didn't really want us to study anything, which was super bizarre for me because I had set myself up to just get wrecked by all the material that I was about to learn.

Instead, they spent six weeks trying to get us to write down our priorities in our lives and to really focus on what hobbies we wanted to keep and things like that. And so for the first six weeks, they set our class's foundation to be putting our mental health and our priorities first.

After they did that, I think when I actually started learning the material, yes, it was fast-paced, and, yes, it was still a lot. But because they had set us up with that foundation that we needed, I don't think it took as long as it has traditional students to be able to find footing in what success looks like for them.

At the very beginning, when I was going into that introduction Transition to Medical School section, I had a lot of similar thinking patterns to any other student about what I wanted my quiz scores to look like, what I wanted my ranking to look like, what I wanted my studying time to look like, or whatever.

But as those six weeks progressed, I started to focus on more about what I wanted my life to look like. Not what I wanted my grades to look like, but what I actually wanted my life to look like.

I knew that I wanted to be happy. I knew that I didn't want to get divorced because, unfortunately, that statistic of med students that get divorced during medical school is outrageously high. So that freaked me out. And then I knew that I wanted to put my family first because they're all in Utah. And unfortunately, because of how busy we are, we never really get to see or talk to them, and they're literally just down the street. So I knew I wanted to put those things first.

And then as I actually started into the curriculum, I was able to say, "This day of the week is my date night with my husband." Regardless of how I feel about this quiz coming up, that is reserved for us.

And so I was able to keep my mental health pretty good during my first year. Of course, there were some hiccups here and there, but overall, I think that their transition into focusing on what success looks like for us as a class has really helped us flourish.

Alizah: Do you think your class has adapted to this new idea of, "I want my life to look happy instead of this myth of, 'Well, it's four years of terrible, terrible, terrible. And then surprise, four or five more years of terrible, terrible, terrible for residency'"?

Jacob: That's a great question. I think it honestly just depends on the student. I think the people that I choose to surround myself with think very similarly.

But I think where that comes from for me is when you're an attending in the future, life is not easy, right? Regardless of what specialty you go into, you've finished residency, you're an attending, and now you're fully in charge of patients. That hardship doesn't just go away because you're a med student or you're a resident or you're attending or whatever. There's always going to be that hardship.

And so that's always been my perspective on it, is I don't just want to sacrifice my mental health for these four years, because then in residency, I'm going to sacrifice it again. And then when I'm an attending, I'm going to sacrifice it again.

And so if you can figure out how to put these priorities in your life early and really stick to them, I think it'll save a lot of hardship in the future.

Austen: I think that's so valid and so fair. And I really like that perspective, because it's easy, especially when you're earlier on in your journey, to be like, "Well, it can't get worse than this. This will be temporary, it'll be hard, but then one day I'll be free." And that's not the case.

So no matter what stage you are in your training, it's going to be difficult, and it's going to be difficult for different reasons. And so being very intentional of what you want your life to look like because that's the thing you have control over, kind of. You get to decide what your priorities are, and you get to decide what you give your time to.

What are your thoughts, Dr. Rooney?

Alizah: I definitely, I think, share a similar experience to you, Austen. And maybe this is TMI, but welcome to "Bundle of Hers." So you get a little special tidbit into Alizah's life.

I remember being at my therapist and being like, "This can't go on anymore." And truth be told, I was failing every quiz. I was like, "I am failing every quiz, so every two weeks I go into a depressive episode on the hour." And then after taking my quiz, I try and get myself back hyped up to do another two weeks of studying only to be sad again. I'm like, "This is the worst thing I've ever signed up for. I have to get out of it. What do I do?"

Because medicine is what I considered my calling, I was like, "Well, I can't leave medical school, so I have to adjust. I have to shift what success looks like for me."

And during that time when I was going through my cyclical . . . It was cyclical in the nature that it wasn't during the winter. It was just every two weeks. I literally just went skiing one whole week. That's kind of elitist, and I'm not saying that's a solution, but I was like, "I just want to ski, and I want to go at speeds that thrill me, because that's the only feeling I can have right now outside of my super sad, pitiful me moments."

And so that's kind of when I adjusted my perspective of what success looks like. And that week, my definition of success was like, "Well, how many vertical feet can I get by the end of Friday?"

And my concern and my worry and that old antique perspective to this is, "Well, welcome to med school, honey. In my day, we didn't leave the hospital for two years." And I'm like, "Whoa, that's a lot. I want to honor your sacrifice, but whoa."

I guess where's the line between being hard on yourself to get these achievements, which are so innate to us, I think, of being high-achieving, being kind of in this "come to medical school, get high grades, match into programs," versus being harsh to yourself and being like, "At what cost do these things come at?" Where do you guys draw that line, and how do you know when you've crossed it?

Austen: Alizah with these phenomenal questions. I cannot emphasize this enough. Really love this question that you've posed, because I think that is something that so many people struggle with. Struggle with being hard on ourselves to help us grow, and then being harsh, being unkind to ourselves, and being detrimental to that growth.

I think that is something that I feel is so valuable to be able to recognize, whether you're in medicine or you're not. I feel like no matter what path you take in life, hopefully you want to grow. You want to grow, and you want to get better. You want to hone your craft. You want to feel like you are valuable in society and contributing in whatever way you feel called to do.

And so I feel like for me personally, because I can only speak to my own experience, I think in the past when I have been hard on myself to the point of being harsh to myself, that's when I lose focus and lose sight of what I'm supposed to be doing.

In order to grow and improve, we need to kind of be hard on ourselves sometimes. And not mean, but just like, "Well, today was kind of a lazy day, so tomorrow I'm going to make sure that I'm focused and I'm getting up early and I'm studying. I'm doing whatever I need to do to accomplish a goal that makes sense for me."

But when I've been harsh on myself, that's when I start questioning my capabilities, I start questioning my worth, I start questioning my life goals and plans.

And I think life goals and plans are something that need to constantly be reevaluated and revisited as we change and grow as individuals. But I think, for me, the line is drawn if I'm being too hard on myself, and then I start to think, "Well, obviously I shouldn't be here." Then I've crossed a line.

Unless you don't want to be in whatever training you're in, unless you don't want to be in the field that you're in, you deserve to be there. You have a spot. You've worked to be there.

Jacob: Yeah, I completely agree with everything that Austen said. I feel like the times in my life where I've been at least feeling the most depressed . . . Or Alizah, like you said, you would have these two-week periods of you'd feel good, you'd study really hard, you wouldn't do very good on this quiz, and have to start over.

I feel like the times where I've felt like I'm going through that cycle is because I've started to lose my focus on what I'm trying to do, or I start to get overwhelmed by all the little things that I have to do.

And so I've found that when I'm able to zoom out, I'm kind of able to pull myself out of that and really look at the big picture of what I'm trying to do.

Then I also feel like Austen talked a little bit about working really hard to get somewhere. Yeah, we do have to be hard on ourselves, because as future physicians, there are things that we have to do, like our board exams. We have to pass our classes. There are things that we don't have an option to say no to.

And so we do need to be hard on ourselves and say, "You know what? I didn't do great on that last quiz or test. I'm going to change X, Y, and Z, and I'm going to do better."

And then similarly to what Austen says, when we're starting to be harsh with ourselves and starting to have that negative talk towards ourselves, and it switches from being hard and making constructive goals to make us better and shifts into this really harsh, dark internal monologue, we shift into this depressive episode where nothing is really getting done, nothing is really getting better. You're present, and you're studying, but nothing is sticking.

And so I think that having a balance there of maybe some tool. I know for me, when I start to be super harsh with myself, I just kind of walk away from it altogether. That's when I go do a hobby or an activity that I like to do, and it kind of resets back to making the constructive criticism and goals for myself and being more hard and pulling me out of that harsh zone.

Alizah: A step back is actually a step forward sometimes.

Austen: Oh, I like that. A step back can be a step forward. I feel like Austen a few weeks ago could have used that. I got my evaluations for neuro recently. I liked being on neuro, and I had a good time, and I felt like I contributed and felt like I learned.

Then I got my evaluations back, and the words were nice, and the numbers were so middle of the road. I was about to go into the OR on a different rotation, and I literally shut down. My brain was like, "Oh my gosh, girl, what are you doing about to go in and see a patient when obviously you have no business seeing patients?"

Alizah: Oh, wow.

Austen: I think it's interesting having this conversation because you can redefine what success looks like to you. And I think that's something that is so important and so critical.

It's one thing to kind of redefine what success looks like to you and overcome your internal monologue, and it's also another beast ignoring what maybe outside sources are saying and kind of continuing with that and being like, "Well, maybe I didn't get all fours on this rotation. Maybe I'm not going to honor this rotation, but I can still be successful. I can still have meaningful patient interactions. I can still become the physician I want to be."

Sorry for that tangent. I just . . .

Alizah: No, that's not tangential at all. I thought that was very meaningful. Thank you for sharing that, Austen.

Austen: I wish I had talked to you two before, because I think it would have really changed things for me that day.

Alizah: It's almost like we should listen to our producer and record in advance sometimes.

Austen: Yeah. Shout out to Chloe.

Alizah: Shout out to Chloe. It just reminds me, this whole conversation . . . I remember Brody Malone, one of the men's Olympians in gymnastics, was saying sometimes you just have to have a short-term memory.

Short-term memory combined with being like, "Okay, that happened. That's long ago. This is what success looks like for me today. And if that means I'm going to eat my vegetables when I go to order my sandwich, that's a win, and that's okay. That's enough."

I don't know. It's a fine balance between being kind to ourselves, I think. Sometimes we're not too eager to do that.

Jacob: I just wanted to say I'm very grateful that Austen brought up evaluations from other people. Because it's all fun and dandy to redefine your own success to what that means for you, but if it's not going well with the people you're working with, then you're not doing it right. And so I'm grateful that she spoke to that, because it's true.

Even before clinical year, I think that there's room for students to be able to ask other students and/or professors or teachers about ways that they can improve other than just in their grades.

It's also an interesting point to tie it back to being hard and harsh on yourself. Austen talked a little bit about opening these evaluations and then walking in to see another patient and really having a hard time being present. And I can only imagine, because I've opened test scores and things like that right before meetings and stuff, and then your brain is just everywhere except for that meeting, right?

It's interesting because if you're able to quickly set those goals and say, "You know what? I'm actually . . ." It's very hard to do, but say, "I'm not going to let this bother me, and I'm going to take this evaluation as something that can make me better," and then walk into that patient room and give them the exact same experience that you're hoping to as a future doctor.

And so I do think there's a fine line there, right? We get these evaluations, we make goals and implement those into our future, but at the same time, if that really was the best that you could give at the time, then that's good enough.

Alizah: Absolutely. What I'm taking away from this, just to kind of summarize, is because of how personal these things are, in whatever way we define success, there's an obligation in our definition to take care of ourselves, right? That needs to be somewhere written in our declaration of success.

There's an obligation to make sure I'm okay and make sure that the communities that I value or the beliefs that I have or the identities that I hold are taken care of. And I think by extension, taking care of each other as well, which is, I feel like, the whole crux of healthcare. Caring for others and caring for ourselves.

Austen: Beautiful.

Jacob: Wonderfully stated.

Alizah: Well, I guess if that's it, we can just wrap it up. I want to thank the "Bundle of Hers" audience for listening, Austen for being a phenomenal co-host, and Jake. It's always, always, always such a good time. I just love seeing you and talking to you, and I just feel like it's a better day when I get to hear you talk.

For our listeners, if you want to check out our Instagram, @bundleofhers, or our website, you can totally find links there to subscribe, to rate, and review our podcast.

We would love to hear about how you define success, and we'd love to celebrate your success with you. So that is it from "Bundle of Hers."