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Competition Versus Collaboration in Residency

Now that you, the reader, have become housestaff, the time has come to change your mindset from one of competition to one of collaboration with your peers. The path that leads to achieving the MD or DO degree is one of often single-minded pursuit of academic victory — the competition has been fierce.

The entry ramp onto the pre-med highway varies, but once you merge, the constant striving for distinction and perfection becomes all-consuming. An element of Stockholm syndrome may set in such that close friendships and even romance may bloom during these grueling hours and days. Psychologically, the competition to get into the right school, get the top grades, and score the right letters of reference becomes near blood sport. Medicine unconsciously becomes a zero sum game for every applicant to medical school, culminating in participation in the Match for a coveted residency slot. Despite the move towards pass-fail grading for pre-clinical work, the competition perversely has accelerated due to the problematic numbers game that the Match has become.

The transition to practicing medicine, including as housestaff, therefore becomes fraught as the modus operandi for trainees. This hyper-competitive mindset, which carried the new resident to match into a competitive program, must fundamentally change for success to continue.

Competition suddenly becomes counterproductive. Too often the competition continues in the form of bad-mouthing other services, disparaging remarks about nursing or other ancillary staff, derision towards the “outside hospital” or the “local PCP,” hostility towards the ER resident paging for a “stupid consult.” The intern who talks over the senior resident to publicly embarrass him during rounds, is now unprofessional instead of clever. The resident who snarks about the perceived incompetence of a nurse paging at 3 a.m. to clarify an order is now a bad influence on the medical students.

That this behavior becomes the subject of censure, and possibly even remediation by the program, is often surprising and mystifying to the resident. This is a common source of considerable resident stress, confusion and disillusionment in my experience.

A not infrequent reason to find a resident in my office is to discuss the perceived (or actual) sabotage of another resident’s work. Forms of this behavior include the addending of a note with the erasure of the prior author’s name, the co-opting of a case for publication without attribution of another involved physician, and the presentation of a difficult diagnostic dilemma at a department conference without attribution of the ideas of other team-members. This practice is a remnant of that old striving for notice above one’s peers, the hope that one will be recognized for “honors.”

In the practice of medicine, such competition is self-destructive as a physician and potentially puts patients at risk. Medicine cannot be practiced well alone. Every physician is intrinsically reliant on others, whether that is partners, consultants, support staff or interdisciplinary professionals that all contribute unique and critical pieces to the health care puzzle. Your life will be easier, happier and paradoxically more successful once you abandon the former competitive mindset.

Housestaff are well-trained in the pursuit of personal excellence. A collaborative mindset will change the definition of excellence to achieve the broader goals of the professional of medicine and allow for personal meaningfulness in the work and a sense of success over the long haul. The sense of victory resulting from another’s mistake or error is an error in the practice of medicine. Medicine is not and can never be a zero sum game. All providers are functioning in a highly strained interdependent system.

Wellness and professional excellence will not be achieved on one’s own. We need to embrace our colleagues, respect their struggle, and raise each other up to be successful. This is not to say that we abandon the pursuit of personal excellence, only that our individual success is now intertwined with the success of the entire team which must be our goal as a profession.

I suggest incorporating the following practices into your daily work:

  1. Identify your team. Recognize that no team wins when there is only one member.
  2. Recognize that a team captain works to elevate each member of the team to achieve success. Celebrate, promote and thank every member of your team. Support your team when things get tough.
  3. Tell yourself that you have achieved your goal by becoming a physician — now your charge is to bring together an excellent team to provide the best care for your patients or to perform the best research to move the field forward.

Practical Wellness: Perspectives from a Program Director

A program director’s perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.

Image sourceCurves by Rosmarie Voegti licensed under CC BY 2.0.

Lara K. Ronan, MD Lara K. Ronan, MD (5 Posts)

Attending Physician Guest Writer

Geisel School of Medicine at Dartmouth


Dr. Ronan is an associate professor of neurology and medicine at the Geisel School of Medicine and is the program director of the Dartmouth-Hitchcock Neurology Residency.

Practical Wellness: Perspectives from a Program Director

A program director's perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.