Peter Brindley and Matt Morgan: Advice to medical school applicants—be average

Why we shouldn’t be afraid to admit to failure

Despite a darn cold winter, well-scrubbed medical school applicants are currently sweating in interview chairs. This is despite knowing most of the questions they will receive, and despite having prepared assiduously in the bathroom mirror. “What strengths do you possess?” a world-weary interviewer will underarm bowl. “Well, let me think about that” the candidate might reply as they feint surprise at this delivery. They are then likely to hit it to the boundary with a statement about “leadership” and “perspicacity.” When the interviewer tries to explore their “weaknesses” they are just as likely to dispatch this predictable Yorker, “Well, people say I’m a perfectionist”. And so it continues: day after weary day.

Many wonderfully talented people apply to medical school, and most have noble intentions. However, every system produces the results it is designed to. Instead of your- or my– ability to trample the competition we really need to explore what makes you, and me, decidedly average. Moreover, what do you intend to do about your “unremarkableness” with a state subsidized training and enviable job security. How about we focus less on the leader you will become and more about the follower you will need to be. This gets short shrift, raised eyebrows, and air-sucked-through-teeth. After all, we live in a society that equates service with passivity and the failure to “be all you can be”. These beliefs are as pervasive, solipsistic, and daft. Firstly, lets accept that the lowly toilet has saved more lives than any doctor ever could. Secondly, not everybody leads, and even titular leaders do not lead all the time. Everybody is an assistant during most of their life. This is true in the hospital, just as when these authors head home and become decidedly “second-in-charge” to the domestic general, be it behind your child, your spouse, or your dog.

Being a follower does not automatically make you a “sheep,” just as being a leader does not automatically make you an all-conquering hero. You would never know this from the medical and business literature. It is awash in books and pamphlets extolling the champion. It is largely mute when it comes to the larger and less vocal majority. Modern workers are rarely passive subordinates. Instead, we/they are all educated, expected to problem solve, and able to influence or to disrupt. These roles matter, and therefore warrant just as much reflection and tenacity. Perhaps it is more comforting to cut ribbons and raise champagne flutes outside of so called “centres of excellence.” In contrast, why don’t we celebrate those who deliver unglamorous help to those most in-need. How often do we ask: “what is needed of me?”, rather than “what do I need?”

It has been wryly observed that the closest a person gets to perfection is the night they write their resume. Moreover, success has 1000 parents, whereas failure is an orphan. Fortunately, some scientists are fighting back and wearing failures on the sleeve of their lab coats. They have posted “failure CVs” in which they list degrees that they did not get, programs that shunned them, and papers that were summarily executed. 

In fact, quitting should be heartily encouraged to maximize opportunity costs if you can psychologically accept the sunk costs.

This is not false modesty. If less than 20% of grants and fellowships are accepted, then good scientists know to get immunised against failure, and fast. Modern parenting and the consumer society are unlikely to help in this regard.

We wish applicants all the luck that they deserve during this interview season. We also understand that the Buddhist gift of “not getting what you want, but rather what you need” may sound obnoxious coming from two old chubby white men. However, we can tell you that most of the best doctors failed to get in the first time, and that adversity can be a terrible thing to waste. We also believe that great medicine is about doing the right thing when nobody is watching, and will often make you unpopular. As one of our famous philosophers once said, “It is our choices that show what we truly are, far more than our abilities.” (Albus Dumbledore).

In contrast, interviews and oral exams are more about theatre and omniscience. We look forward to welcoming you to this marvellous and difficult profession. We look forward even more to you pointing out our deficiencies. Please help us to be, if not great then, exactly the type of average that our patients need.

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan

Peter Brindley, Professor in the Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. He is on twitter: @docpgb