Competitiveness Can Undermine Team Goals

Abstract

Adam and Emmett had just finished their third-year clerkships and were doing their first elective. Both had chosen orthopaedic surgery, hoping eventually to be selected for a competitive orthopaedic-surgery residency. Adam's heart had been set on becoming an orthopaedic surgeon for quite some time. He had grown up with an orthopaedic surgeon as a father, and he remembered a conversation with his dad right before he started medical school that, in retrospect, had been a real turning point in his life. His dad had said he would be proud to have Adam join his practice. It was the first time his father had said anything like that. They had talked about it off and on in the years since then, and Adam had grown increasingly interested in the idea of doing orthopaedics and joining his dad's practice, knowing it would mean a comfortable life.Adam received good clinical grades, scored above average on USMLE Step 1, and continued to develop an interest in orthopaedic surgery. The pressure to do well on the orthopaedic rotation, get a good letter of recommendation, and rank among other well-qualified applicants prompted Adam to become increasingly competitive.He began arriving before Emmett in order to pre-round on both his and Emmett's patients, hoping that he would be able to answer a vital question if Emmett faltered. Adam was initially disturbed by his increasing willingness to be so competitive, especially at the expense of another student. But, over time, he grew accustomed to it, driven by the prospect of joining his father's successful practice. He reasoned that surgery was difficult, and the competitive culture actually benefited patients; it meant more people were being attentive to the details of each case. He wondered if he was upsetting Emmett, but told himself that Emmett was free to be just as competitive and that, in the end, the harder working, more deserving student would be selected to an orthopaedic residency spot and make a better surgeon. Commentary 1 by Jeffrey Reagan, MDThe task of securing an orthopaedic-surgery residency or any competitive residency position can be difficult and nerve wracking. With increasing enrollment into medical schools and relatively few orthopaedic-surgery residency training positions, prospective students must find ways to stand out from the crowd. This is not a new concept for students; it is not unlike the process of being accepted into medical school. Candidates must have excellent medical school grades and USMLE Step 1