Competency: Practice-Based and Lifelong Learning
Goals have served as the guideposts of my life for as long as I can remember. While early goals yielded coin collections and Pokemon cards, these small victories gradually laid the groundwork for goal-driven achievements in music, research, and academia that eventually led to one of my biggest milestones to date: a spot in the class of 2021 at the Ohio State University College of Medicine.
During my surgery rotations, I had the goal to rank in the top 10% of students on my surgery shelf. I didn’t achieve it. While I have succeeded in some similar goals throughout my time in medical school thus far, I have failed to reach enough others that I have begun to question whether my efforts in goal setting these past few months have been misguided. In college, my goals regarding excellence in class grades provided needed motivation to work longer and harder than my peers which served me well. However, it has become clear with time that such a strategy as a medical student is no longer sufficient to yield the excellence I’ve been striving for. While reading the book Atomic Habits I received some insight as to why that may be.
I started reading Atomic Habits in the effort to improve in my ability to set and achieve goals. One can imagine my shock when I read the advice of the author, James Clear, to stop focusing on goals. As strange as this sounded to my ears, he explains his position in his book by listing some of the biggest problems that can arise in goal-oriented efforts. The first he lists cut right to the heart of my current struggle: “Problem #1: Winners and losers have the same goals.” This has never been more true than it is in medical school. Everyone has the goal to do well on these shelf exams. It was his second and third listed problems, however, that really started to inspire change in the mentality of my goal-oriented behavior: “Problem #2: Achieving a goal is only a momentary change.” “Problem #3: Goals restrict your happiness.”
While it is true on a large scale in that I am guilty of restricting happiness until the achievement of scholarly goals, problems 2 and 3 have often been true in my day-to-day efforts in medical school. My hope of scoring well on my surgery shelf exam inspired me to complete a defined number of practice questions and flashcards each day. Like a carrot at the end of a stick before a donkey, I trudged through flashcard after flashcard and question after question each day in hopes of achieving the satisfaction of a top score on my surgery shelf at the end of my rotations. To say I was burned out by the end of the rotation is an understatement.
So what is the solution if goals are not the be-all and end-all answer to satisfaction and success? Clear explains his answer to that question as follows:
“What do I mean by this? Are goals completely useless? Of course not. Goals are good for setting a direction, but systems are best for making progress. A handful of problems arise when you spend too much time thinking about your goals and not enough time designing your systems.”
He further suggests an examination of goals themselves to determine whether they are based on outcomes alone or on identity. Clear suggests that identity based, rather than outcome based goals are associated with a far deeper, more lasting level of change.
This made sense to me. I had become a slave to my goal in a way that had stolen the joy and power from the journey (i.e. “system”) that was supposed to be leading to success. As I looked closer at the system I had in place to achieve my goal of scoring well on the surgery shelf, I realized that it wasn’t much of a system at all. My tunnel vision on one test score had led me to continually try to work harder, not smarter, at the expense of other aspects of my life. For example, while I’ve in the past maintained that one can always wake up 30 minutes earlier than usual in order to get a work-out in, successive failures to meet my flashcard quota led me to cut my workout from my schedule and, little by little, carve time from my normal sleep schedule until I could take out no more. Early struggles with practice questions led me to replace my daily leisurely listening of fictional audiobooks with study books containing shelf-related material. I even stopped meditating and struggled to find time to continue to cultivate my hobby of photography.
Examining all this as Clear recommends made me realize I had placed so much dogged focus on one transient goal, that I had missed the meaning behind that goal and had failed to make other identity-based goals to keep my life balanced. Thus, rather than focusing on test scores, I began to make goals in line with my aspirational identity as a creative, healthy, life-long learner. Does achieving these identity-based goals involve sacrifice, hard work and long hours? Absolutely, but the nature of an identity-based goals like these suggests a life-long pursuit with every single day an opportunity for success and satisfaction rather than looking for this transiently in some future test score.
Implementation of these changes in the type of goals I set and the way I work to achieve them has helped me to truly flourish, and not just academically. While the Step 2 score report below represents the fruit of months of consistent learning every single day, it is the daily satisfaction of that learning that has carried me beyond the exam and will continue to motivate me for years to come. Furthermore, as I have stayed true to my identity as a creative, the photo below it which won an award in the College of Medicine’s, “Ether Arts Magazine”, represents continued evolution of skill in the modality I use to express my creativity: photography.
As I move forward into what will be a very time-intensive chapter of my life, I will seek to hold fast to these identities in every day that I live. Furthermore, finishing this portfolio has reinforced my desire to make reflection a part of my identity. I will use daily journal writing and photography to further reinforce this and all other identity-based goals I develop. I believe that doing this will help me to flourish in residency just as I have as a medical student at the Ohio State University College of Medicine.