Practicing Teamwork in the Healthcare System

Before medical school I ran middle-distance events as part of my college track and field team. While largely thought of as an individual sport, it takes a team effort to win track meets. This was exemplified during my junior year when my team unexpectedly won the conference championship. We were not picked as favorites that year but little by little points scored across the team added up. Everyone’s individual efforts mattered, and with scorers from all facets of our team we were able to take home the trophy. I see a lot of parallels to be drawn with regards the team-based approach to patient care within our health care system. Rarely anymore is one physician making all the calls in the hospital, rather the case is discussed in detail every morning by a multi-professional rounding team. Even on the outpatient side the goal is to connect patients into a “medical home,” with different offices and practices working together. Everyone plays an important role and functioning as a team is required for successful patient care.

During my third-year clerkships I’ve been fortunate to have worked on many excellent healthcare teams. One particular standout is the month I spent on a general medicine inpatient service; never before had I been part of a team that worked so efficiently together. I came home every day energized and excited by how much I had learned, how we had helped a patient that day, and how much fun I had had! I took special care to note what specifically made this a wonderful experience:

  1. Everyone did their job well. The anesthesia intern was one of the most efficient residents I had ever met. This therefore enabled our senior resident to spend time on teaching, leading the team, and checking in with the medical students on pre-rounding. The attending was a fantastic listener and offered teaching points on patient care plans in a way that was supportive and educational.
  2. Communication on the team was strong. In sharing a team room with the case manager we were able to check in early and often about discharge needs for patients. We spoke with pharmacy daily either via phone or in person. We had a system for contacting nursing staff to round with us every day. Our senior resident had prepared a “face sheet” so when we walked into patient rooms they knew who we were and what our roles on the team were. Discussions about patient care decisions were supportive and collaborative, I was never afraid to ask questions.
  3. Expectations were laid out early and clearly. It helped me immensely to know what my role on the team was, how learning would be taking place, and when to expect feedback. I was encouraged to come up with goals for the month which were then written and hung on the wall of the team room for accountability and frequent progress checks. Everyone was on the same page, which helped everyone fulfill their role successfully.

Evaluations of me by my peers for team-based learning assignments.

This teamwork not only benefited my teaching, it allowed us to provide a superior hospital experience for our patients. Our collective efficiency allowed us to spend more time in patient rooms discussing the care plans, and if patients ever had any questions each team member was equally prepared to answer. The positive, supportive energy of our team gave us the capacity to be more empathetic towards patient concerns. We had a difficult case that month where a woman on our service wanted to leave AMA. Our team went to speak to her, and over the course of discussing why it was important to stay in the hospital the conversation kept coming back to the patient’s desire to go home and drink a Mountain Dew. We tried to explain her disease process, and to impress our worries for her safety, but again the patient responses all circled around not being able to get a Mountain Dew. I think it would have been very easy to continue to try and force our agenda here had team members been more stressed or burnt out, but it became apparent that it was less about a Mountain Dew and more that the patient felt that she wasn’t being respected in the hospital and people weren’t listening to her. We regrouped and acquired (almost magically, given hospital cafeteria rules) a Mountain Dew from one of my classmates’ medical school lockers; by bringing the patient the Mountain Dew she was immediately appreciative, trusted our team more, and was ready to discuss her treatment plan. Through this small gesture we were able to meet the patient where she was, so-to-speak, and give her back a component of dignity and humanity she felt she had been denied prior to this. She ultimately went on to get all the necessary tests and was able to be safely discharged shortly thereafter.


On the other hand, I’ve sadly also seen how poor team dynamics can negatively affect patient care.  On a different general medicine service later in the school year I was part of a team where the senior resident and attending physician openly did not get along. I felt somewhat lost in my role because expectations held for me by my senior resident differed slightly from those of the attending. Team communication felt more strained, and team members on all levels seemed more stressed. While I still feel we were able to provide safe and effective care for patients, I don’t think it was quite at the level of empathy and patient-centeredness as my other gen med experience. We had a patient during this time who had been admitted for treatment of a severely infected wound as a result of injection drug use. While initially she was very worried about her condition, she became very irritable as symptoms of withdrawal set in during the afternoon and she ultimately AMA. As a team we had offered treatment for withdrawal symptoms and resources for social concerns, but we couldn’t convince her to stay for treatment. After she left I couldn’t help compare her case to the patient who had wanted a Mountain Dew; I felt like we didn’t do as good of a job of meeting the patient where she was in this case, and I think a major reason for this was the added strain on our team from poor team dynamics. Team members including our senior resident were more burnt out and less able to give patients the empathy and patience required to care for them.


In graduating from medical school and going into residency next year I will be playing a new role within the healthcare system, filling a new spot on the healthcare team. In order to help my team the best, I will need to not only do my job well but keep an eye on overall team dynamics, and feel empowered to make changes if team dynamics are limiting the potential of the team. Part of doing my job well will involve keeping up to date on my medical knowledge, learning to be efficient with documentation and the electronic medical record overall. I plan to further refine these skills during the end of my M4 year through my sub-I month on a cardiology service, and a hospital medicine elective where I will work directly with an attending to practice efficiently carrying a team of patients entirely on my own. I will work on anticipating questions or problems ahead of time regarding medications or discharge plans for my patients so I can communicate effectively with other members of the care team, including pharmacists, case managers, and nursing staff, to resolve those problems early. And finally, I will check in with and watch out for other members of my team, because after all that’s the greatest benefit of being on a team: whether you’re having a bad race or a difficult day at the hospital, teammates are there to boost you back up when you need it. Teammates are what make the early morning track workouts and long days at the hospital worth it; teammates ultimately help us achieve new PR’s and conference championships as well as deliver the highest form of patient-centered care.

Getting some team-based splinting practice!

Transitions Driving Lifelong Learning

The transition from the pre-clinical years of M1 and M2 to third-year clerkships is a stark change. Gone is the flexibility of setting your own schedule, watching lectures from coffee shops and taking an organ-by-organ approach to clinical reasoning. Gone is the relative stability and sameness; this all gets thrown out the window once you embark on your M3 journey. Suddenly, schedules are at the mercy of the particular service you are assigned to, clinical reasoning no longer occurs in multiple-choice questions, and once you get comfortable in a particular rotation your time there is up and you are on to the next team. You see a lot, do a lot, learn a lot as a third year, and while it might be feel a bit more rigorous than the prior two years, you are rewarded with the privilege of direct involvement in patient care. You can’t help but pause and think that this finally is what you came to medical school to do – but of course you don’t pause too long because there are shelf exams to stud for and residency choices to figure out.


Having had little exposure to clinical settings beyond being a patient myself prior to medical school, adjusting to clerkships was far from seamless. Unexpectedly, one problem I struggled with most early in this transition was wondering where on Earth to find information to answer the clinical questions I had. My first two years of medical school were spent internalizing a multitude of PowerPoint lectures with clearly defined objectives. Information was presented in a particular, predictable order: “here is an antibiotic, it can cover these bugs, and is contraindicated here. Here is another antibiotic, which covers similar, but different bugs, and can’t be used in these situations.” Now in a primary care clinic, I found myself caring for a patient with a simple bacterial sinusitis. “What antibiotic do you want to give them, Rebecca?” The order was all off, and I struggled to invert the information I learned in the lecture hall. “Vancomycin?” I suggested. My attending’s facial expression told me that this patient wouldn’t be getting vanc. “Well sure that would cure it all right, but it’s only IV and a really heavy drug for this. How about… amoxicillin?” Yikes, I had a lot to learn.

Thanks to enthusiastic residents, patient attendings, and supportive classmates I soon got the hang of being a third year. I had enjoyed the success of mostly glowing evaluations, passing shelf exam scores, and even academic “honors” in several specialties, and therefore approached fourth year without trepidation. Again, however, I was met with unexpected challenges in making this next transition. I spent July filling a new role as “sub-I” on a hospital peds team, where I first struggled finding balance in straddling the line between medical student and intern. The team had a brand-new senior, a guest rotator intern, myself, and several M3’s, all trying to navigate unfamiliar roles for the first time. I struggled to figure out where to fit in this team dynamic; with a low summer patient census I worried about taking patients away from the M3’s. I struggled asking for more practice with placing orders, knowing that my inefficiency would slow our team down. Finally, amidst this chaos of learning how to be a sub-I on the busy, ever-revolving door of a hospital peds service, I was told by an attending for the first time in my medical training that my medical knowledge was not at the level where it needed to be. This was crushing. This was unexpected. This was not how I planned this month to go.

This feedback rocked me, so what came next was a lot of introspective re-evaluating. I went over and over in my mind what I felt wasn’t working, and belabored the issue with my fiancé at home. Things started to turn around when I started using down-time on service to talk to my senior resident. It was helpful to get an external perspective of how I could improve. I started similar conversations with my two attendings, revisiting the goals I had set at the beginning of the rotation. My senior and I came up with ways that would both help my learning and reduce his workload while maintaining team efficiency. From one attending I learned of pediatric review resources to get quick information on some of the most common pediatric illnesses. The other attending and I developed quick, small goals to work on overall confidence. Finally, I had a plan, and in that plan I no longer felt lost in my role as a sub-I. Slowly, the month started looking more like what I expected going in.


It was an uncomfortable month, but one where I felt a lot of growth. Before medical school I ran the 800m on my college track team; between sets of repeats on the track my coach often preached the concept of “learning to be comfortable being uncomfortable.” I see this translating now into my medical training, as new rotations, new responsibilities, and maybe even living in a new city for residency will continue to push me into the realm of “uncomfortable.” But these opportunities are how I grow as a physician, and these struggles are what I will someday draw on as I teach future trainees as a resident and attending. As a resident I will work to meet these challenging transitions by being patient with myself when I’m not achieving at the level I expected for myself, and communicating with those around me when I feel like I need help or advice. I will set small, measurable goals to help me achieve overarching milestones. Similarly, when I someday work with students and interns as a resident I will remember to give targeted feedback with specific things to work on or address, because I saw how that has helped me develop a plan for improvement during last July. And because everyone’s progress looks differently, I will avoid comparing myself and my experience to that of my peers.  I was relieved when my sub-I month came to a close, but then it was just on to the next month.

How Palliative Care Helped Improve my Patient Care

One of my favorite parts of medicine is getting to speak with patients and their families. The privilege of interfacing with patients is predominantly why I chose medicine; I enjoy talking to patients not only about what brought them to the hospital, but also the things at home they look forward to returning to after discharge. I remember a week on my general medicine clerkship where I was late for rounds several days in a row; each day I’d catch up with the team just as they were setting off from the team room, saying “sorry the patient was chatty!” By the third day I realized I had said that about three different patients, and the limiting reagent was probably me.


But while talking to patients is enjoyable, I found myself always gravitating towards happy subjects. Like the plague, I avoided more difficult subjects and bad news of all sorts. I have somewhat of an innate tendency to be a “people pleaser,” which sometimes causes me a good deal of personal stress from being unable to say no. I’ve always felt it was absolutely worth it to just do something rather than upset someone by explaining that I’m too busy or not interested. This habit has been problematic at times in the hospital as well, where bad news can be common and my inclination is to always answer in the affirmative. (Example: “Sure, it’s possible that you could be ready for discharge tomorrow!” — I learned early in third year that patients better be actually ready for discharge before you start suggesting it.) To address my fears of delivering bad news I forced myself to sign up for the uncomfortable realm of palliative care, a rotation I completed in August of this year.


Going in I was very nervous, I honestly hadn’t seen anyone die at all during my third year, and I had stayed away from very sick services such as heme-onc on purpose. Being rather uncomfortable with the idea of death myself, I wasn’t ready to discuss it with anyone actually facing it anytime soon. I started the rotation on the main hospital palliative care consult service and felt immediately more comfortable after meeting the team. There were a lot of people involved, including an attending, fellow, nurse practitioners, and chaplains, and everyone was so warm and welcoming. I was prepped with a brief discussion of common consults that might be seen on the palliative service, and the conversation tools used by palliative physicians to talk to patients about difficult issues. I found it helpful to learn that there was a sort of “toolbox” of conversational techniques, and the most important part of the palliative job was to listen to the patient to decide which one of the tools should be used. An end-of-life conversation was viewed as something of a therapeutic procedure, which allowed me to conceptualize our role in this process better. After just a few days observing conversations between the attending or fellow and patients and their families, I gained an immense appreciation for the work that they do.

Some of my palliative care notes, kept in a small notebook I carry in my white coat.

This experience helped me realize that sugar-coating bad news doesn’t do much of a service to your patients. I saw patients with end-stage liver or kidney disease who were shocked to hear how grim their prognosis was. It floored me to imagine all the encounters they’ve had with medical personnel, and yet they somehow still didn’t understand how sick they were. Part of this, I learned, was simply a defense mechanism of the patient, who had been told but wasn’t ready to confront the severity of their illness. But another major part was the myopic view often taken in the hospital of patient care; we spend day after day on the inpatient services presenting one small problem after another, assessing the status of that problem and the plan to fix it. Leukocytosis, stable. AKI, give fluids. Anemia, continue iron supplementation.  While that helps us be thorough in the problems we treat, I’ve seen that at times this approach might cause us to miss the overall picture. “Patient has liver cirrhosis causing ascites, hyponatremia, and hepatorenal syndrome.” The team might understand that this is a bad prognosis, but we don’t always do the best job expressing this to our patients. There may be a plan in place for every small problem, and we sometimes use this to hide the fact that there’s nothing to do for the overall clinical picture.


One reason I seek to avoid delivering bad news is the emotional response that may inevitably be elicited, it’s inherently uncomfortable to see someone else cry. It can be scary to be around someone who is angry. My palliative care experience allowed me to work on this too by teaching me that such an emotional response from the patient means they get it. They heard what you were trying to tell them, they understand the meaning of the bad news you just delivered. And though it isn’t easy, and though you might need to give your patients time to emotionally process, once they have processed things then you can work together with the patient and their family to move develop a plan for moving forward. You can trust that the patient fully understands, and only with their full understanding can you begin to provide patient-centered care.

Following this rotation, I have found that I feel more confident in my patient care interactions and I now consciously make an effort to identify when my own bias to lean on good news might be masking the gravity of bad news. I focus on looking at both the individual problem list as well as the big picture for patients. Finally I try to be a better listener for my patients; palliative care has shown me that the things patients say might not really reflect what they mean. A patient’s question about statistical prognosis may actually be an emotional response to a cancer diagnosis, and it will serve them better to respond with an empathetic emotional statement rather than drilling numbers.


Going forward, my goal is to continue to practice these palliative care skills when opportunities arise. Throughout the end of fourth-year, this will best be accomplished with the support of my senior resident. When bad news needs to be shared with one of my patients or their families, I plan to run through my conversation with my senior beforehand, and ask them to come with me into the room as back-up. I will follow the tools I learned in palliative care, including reflective listening, reframing, empathy, and allowing for silence. At the end of such encounters, I will debrief with my resident, and ask for feedback on what went well and what could have gone better. As I become more comfortable with these skills I can work with my senior to start to cut back on some of the safety net that they provide.


I am extremely grateful my experience on palliative care this past summer. I know that delivering bad news will be a necessary part of my medical career as well as my personal life, and I feel it is very important for me to be able to do this in a way that is supportive for my patients.

Taking Interpersonal Communications Less Personally

For the sake of patient care efficiency in the team-based hospital approach, interprofessional communication is vital. Communication in the hospital can be tricky, however. Everyone is busy, patient care can be demanding, and patience sometimes runs short, resulting in less-than-professional communication styles. I’ve seen this played out in grumpy consultants, disgruntled nursing staff, and burnt-out residents. Ever the “people-pleaser,” these examples of communication breakdowns have caused me to be rather anxious in my communications in the hospital, but it’s hard to feel confident when I’ve witnessed exchanges complaining of the rudeness of someone’s tone, or the incompetence of whoever placed a particular consult. Fortunately in medical school I’ve had several experiences from which I can draw confidence in my interpersonal communications.


I’ll admit that much of this anxiety comes from my personality trait of being a people pleaser to a fault, I will go to almost any lengths not to make someone upset. I think I also have a unique take on this as a woman in medicine, trying to walk that fine line of not being too bossy or pushy while trying to get things accomplished for my patients. There’s a tendency to be almost overly polite, to apologize for things that are not my fault.


During my first year of medical school I got involved in the leadership of a student group called Life Events. Life Events is a branch of the overarching Humanism in Medicine organization. My interest in this group stemmed primarily from a desire to simply meet more people in my medical school class; students could nominate a classmate going through a positive or negative life event and our Life Events group would then help celebrate or acknowledge the event through hand-written cards and baked goods, usually left in the school counselor’s office for the nominee to pick up at their convenience. We celebrated weddings, pregnancies, and new American citizenships in our class that year, and sympathized over lost loved ones, ill family members, and academic difficulties. At times Life Events submissions came at inconvenient times and I found myself feeling stressed about having to put something together the week before a final exam. But suddenly I realized that as hard as I might think it is to find an hour or two to bake a batch of cookies while studying, it was probably much more difficult for someone to focus on their studies while worrying about their family member in the hospital. Having been pretty fortunate to thus far have a rather healthy family just a short drive away from campus (I superstitiously get nervous even typing this for fear of tempting fate here), it amazed me knowing what people can carry around with them in their personal lives without showing it. Remembering this helps keep me from getting defensive if a patient is difficult, a nurse’s tone is curt, or a consultant sounds frustrated over the phone. It helps me not take things personally and encourages me to give others the benefit of the doubt. Taking this step back and considering the human experience of those around me makes me less sensitive, and ultimately gives me the courage to advocate for the needs of my patients amidst a large healthcare team.

Shortly after passing off Life Events leadership to students in the class below me, I took a break from Step 1 studying to attend a workshop at the student Union called “Stop Over-Apologizing.” This was an interactive session during Women’s History month on why women feel the need to always be saying sorry for things that aren’t their fault, and ways to break the habit. My fiancé had already brought to my attention my tendency to say sorry to cars that waited for me to walk across a crosswalk and to the local coffee show employee after they ask me to repeat my order. I felt like I had to go to this session, and when I did I appreciated the discussion on why this was an important issue in the first place: on one hand it diminishes the meaning of the word sorry when it’s used too often for trivial matters. But perhaps more importantly, it detracts from my personal feelings of confidence in my abilities, and may detract from the confidence other people, including patients, place in my knowledge and skills. Throughout my M3 clerkships a frustratingly common piece of feedback I was given was “be more confident.” It was frustrating because it felt like such a vague, broad goal, but breaking it up into smaller pieces has helped me, and tackling my apologetic tendency is one small piece.

The flyer for the Women’s History Month event calendar, still saved on my phone since I forwarded it on to friends.

If I’m being honest with myself, I probably haven’t made the progress I like to cutting back on unnecessary apologies. One way I’ve been doing this is asking for accountability from those around me: I’ve asked my fiancé to help identify when the “sorry” comes out as a reflex at home. Calling this out helps me identify common situations, and then go back and rephrase with a more appropriate sentiment. It’s an old habit that is certainly dying hard, but I’m working on it. Acting as an intern during M4 sub-I’s has given me many opportunities to develop my interpersonal communication skills, and every week there have been opportunities for me to take a deep breath and remember to give people the benefit of the doubt. This has been harder on longer, busier days, but these are the days when it’s most important. I can keep working on this by speaking about colleagues and patients respectfully and encouraging my team members to do the same.  In working to set a precedent of positivity in my interpersonal communications I can encourage others to do the same.

Teaching to Enhance Medical Knowledge and Skills

Learning in medical school is said to be like drinking from a fire hose; you are constantly bombarded with new information and you have to retain as much as you can. And then once you’ve learned so much about the human body you find yourself discussing paradoxical emboli in casual conversation, you embark on the challenge of applying that knowledge you’ve learned in the classroom in the real-life setting of the hospital. You find it’s almost never quite the same as in the books, and are surprised at the amount of re-learning you do. Medical school is inherently difficult, and acquiring this medical knowledge is certainly intimidating.


Although it is rigorous, the medical learning isn’t all bad. I remember some standout lectures during the preclinical years including a radiology lecture so entertaining I found myself laughing during the middle and an ophthalmology lecture where the speaker teared up while describing a patient care story. These experiences have stuck with me because they helped me realize how conveying passion for a subject can positively impact the learning experience for trainees. These experiences are also what prompted my interest in medical education, something that I’ve worked to explore through several extracurricular opportunities in the med school.

Credit to Dr. Alex Grieco, this is a small clip of a notes sheet from one of his lectures during my M1 year. The connections he makes with the audience and enthusiasm he conveys for the subject are what I hope to emulate.

The Peer Elective Educational Resource (PEER) group was one such extracurricular. Through PEER I was part of a group of M2s who made review slides and practice tests for M1s prior to the M1 block exams. This was intended to help M1s sort through that firehose of information while preparing them for the clinical vignette question format. I worked to condense topics to 3-4 review slides and wrote associated practice questions to go along. I found this to be an enjoyable exercise that not only benefited the class below me, but allowed me to develop my own medical knowledge for my assigned topics. It was hard to condense and simplify without a solid knowledge base to decide what’s important. Further, it was impossible to write a good clinical vignette question without a thorough understanding of the topic. Writing wrong answers was perhaps the most challenging part, inventing believable responses that are still clearly wrong. I remember getting an email from a student citing a PubMed article, explaining why one of my “wrong” answers should have also been considered correct. While I initially felt annoyed and what felt like an over-zealous correction, after further consideration I realized that this is one of the great things about medical education: even teachers have room to learn, and students are often a means of learning. Involvement in medical education helps keep you up to date on the most current, evidence-based clinical information, which will not only benefit my teaching, but will also the patients I care for.

Tutoring is another way I’ve been able to further develop my medical knowledge while exploring my interest in medical education. I was assigned in the fall to work with an M2 student through the Neuro, GI-renal, and Host Defense blocks. I drew on my own experiences and challenges from these blocks to add perspective to the material to facilitate understanding. Again, tutoring involved a good deal of relearning along with my student; at times we spent whole two-hour sessions grinding through single lectures. One surprising challenge I encountered early on was how our different my learning style was to that of my student. I consider myself very type-A, and always followed very ritualized review habits that I felt too superstitious to break. My student on the other hand was a little more relaxed, identified more as type-B, and seemed more flexible in his review style. One of my initial goals I set for myself as a tutor was to not inflict unnecessary stress upon my student by trying to force them into my study routine. It was uncomfortable at first to break from my familiar routine, and our initial sessions definitely fell more in line with my study patterns. Reflecting on and recognizing this after our first few meetings, I then worked to let my student guide sessions and ask me questions to initiate discussions. This got easier towards the end of neuro where things are somewhat more clinically-focused, and for other topics that I felt admittedly more comfortable with than neuro physiology (again, this reinforced how you need to know information well to teach it!) Beyond the medical knowledge component I often felt my value as a tutor was simply in empathizing with the challenge of medical learning. Similarly, tutoring has held value for me in getting to share in my student’s successes. I have thoroughly enjoyed the relationship of mutual learning that I’ve developed over the semester through peer tutoring and the practice it has provided me with being able to share my medical knowledge with others.

Medical Knowledge and Skills aren’t just learned in medical school then put on the shelf, they need to be constantly honed and practiced; through teaching I can share my knowledge while knowing I still have room to learn, both on a medical skills and interpersonal level. To continue to develop my skills in teaching one major area I’d like to work on is my confidence in the role of teacher. I’ve found that preparation prior to tutoring or teaching experience helps me feel more confident, so going forward selecting topics ahead of time with my tutoring student will allow me to better prepare for confusing or complicated teaching points. Similarly in residency, prior to starting a new service I can prepare short teaching points while doing my own review for the rotation to share with the students and other trainees on that service. Finally, I will seek out role models who are proficient medical educators and pay attention to the techniques that I could apply in my own teaching.

Work-Life Balance as a Component of Professionalism

All through medical school I heard from upper classmen and residents that fourth year of medical school is one of the best of your life. Your rotations are all in line with your interests, exams are few and far between, you have a lot of vacation time. Now over half way through this golden last year, I find I’m still waiting to experience the magic described by those that came before me. This year has been both busy and stressful, and I kept picking arbitrary time points when I expected things to get easier. But the end of my sub-I month, the ERAS submission deadline, and the end of interview season have all come and gone, and I still feel pulled in as many directions as ever. The cause of this is admittedly a mixture of over-commitment and sub-par calendar management, and when these cause stress levels to peak I find I’m not the most pleasant to be around at home. Excess stress strains my communication style and impacts my productivity, and for this reason I believe that a sense of balance among professional commitments is an underrated component of professionalism.


I have had a packed schedule for as long as I can remember. Going back as far as middle school I can recall staying up late finishing homework after a day of school, soccer practice, and piano lessons. Balancing college athletics with pre-medical ambitions this continued through college, and at this point I get a sense of uneasiness when confronted with free time. There is a level of external pressure which reinforces the drive to always be busy in preparing for medical school or residency applications, and certainly a few of my extracurriculars have been designed to “check off a box,” so to speak. These experiences are usually memorable for me in negative ways, and my performance in these areas was generally less than my potential. Undergraduate research was something I did as a requirement for my degree, and while I was always thrilled by planning the project towards an end goal, I found I couldn’t the procedural aspects of bench research. My project was slow-going and ultimately resulted in equivocal results, and while I gained valuable experience with lab techniques I am sure my project could have pivoted in more promising direction if I had more time to commit to the project and more of a passion for the work itself. Further, my time in the lab took away from other things I enjoyed much more, such as spending time with my track teammates and tutoring underclassmen in my major.

Once I got to medical school I focused more on getting involved in activities that aligned more with my interests. I joined girls on the run as a coach, a community-based organization that teaches elementary school-aged girls confidence and life skills through running. I did a community health project that was based out of the high school I went to. I joined the Peer Elective Educational Resource to explore my interest in medical education. I felt more excited about these events, they came from a place of passion and they all gave me energy to be a part of them. As I continued to refine my interests and career goals, I threw myself into more and more extracurriculars that aligned accordingly. I started a medical education research experience with the family medicine residency program, joined the Ultrasound Interest Group executive board, started a pharmacology medical education project, joined leadership for the Ride for World Health. But as I kept saying yes to things, as I justified to myself how important involvement in all these activities was, I found myself feeling more and more stressed and struggling to maintain the level of quality that I had always expected out of my work. I missed deadlines, forgot to set meetings, and scrambled to meet neglected due dates, and found less and less time to do stress-relieving activities like running.

I started to lose my sense of balance in my professional and personal commitments. In addition to my extracurriculars, I’ve been planning a February wedding with my fiancé, Todd. Let me take a brief pause here to say that doing all these things would not be possible without a supportive partner. As an English minor he helped edit my personal statement in the fall. Just the other day Todd spent several hours cleaning up the Schottenstein center with other riders and myself to raise money for the Ride for World Health. Domestic duties like cooking, grocery shopping, and dishes often fall on his shoulders. We’ve joked from the beginning that we are both in medical school (Todd is an engineer, for reference), and as unexpectedly busy as this fourth-year has been, it’s helped me realize that my career decisions and work commitments no longer affect just me, but rather both of us.

My fiance and biggest support in the medical school process

This brings me back to work-life balance being a vital component of professionalism: such balance helps keep us energized so we can be more punctual, treat patients with more respect, and maintain accountability for meeting our goals (all goals I had set in prior professionalism portfolio reflections). It also helps us achieve a greater degree of quality in our individual pursuits if we are not pulled in too many directions. I am grateful for all my extracurricular experiences, and all they’ve taught me in the way of time management and communication. As I will surely continue to be busy through end of fourth year, I will work to communicate early with involved parties when my commitments overwhelming and ask for help if I need it. I will plan ahead so I don’t run into conflicts between the demands of different organizations. Viewing the start of residency as a sort of clean slate for extracurricular activities, in the future I want to work to be more intentional with my professional involvement. Rather than volunteer my time because something “checks off a box,” I will consider my level of interest, the passion I can bring to that activity, the way my involvement may be beneficial, and weigh that against the time it may require and what toll, if any, it may take on my personal life. I will take time to discuss things with my partner at home, and perhaps with my mentors as well. I see it being difficult to override my compulsion to be constantly busy but finding a balance that works for me will benefit both my personal and professional lives. Balance will provide the resiliency necessary to thrive in a rigorous residency training program and the capacity to act with professionalism in all situations.