This is going to be a multi-part post, because as I started writing it I realized how much I have to say on the subject. I’ve actually thought of writing a book called “How to Succeed in Medical School Without Really Trying.” I’ll keep you posted if that ever comes out.
First, an introduction to the concept:
Those of you who know me appreciate that “work smarter, not harder” is one of my primary life philosophies. I started discovering these principles in medical school, as it quickly became apparent that there were nowhere near enough hours in the day to learn everything I was supposed to learn and do everything expected of me. Medical school has been likened to drinking from a fire hydrant, which is an apt analogy. Out of necessity I started looking at what activities I could eliminate in order to free up time to do the things that were really important. The concept grew from working efficiently so I could do well academically to working less so I could live more (to borrow from The 4-Hour Work Week). “Success” means different things to different people, and no one’s definition is more valid than anyone else’s. The point is to decide what is important to you, and then ambitiously, unapologetically, pursue it. For me, I discovered during medical school that I don’t actually enjoy working that much, especially within a monstrous bureaucratic system. I’d much rather use my time to write, create, and share helpful information with people (a different type of “working,” I suppose). Your goals might be entirely different from mine, but the principles will still apply.
The first three tenets of my philosophy are:
1. Know what you want to accomplish.
2. Understand the system.
3. Ask for what you want.
In a little more detail:
1. Know what you want to accomplish.
Be really specific about what your goal is. For example, one of my goals was doing well in medical school in order to have the best chance of matching at a residency of my choice. It wasn’t because my self-esteem was tied up in the comments on my transcript. This allowed me to focus on the measures of success that would have the most direct impact on my residency application (such as Step I of the boards, clinical grades, away rotations, etc.) and to ignore everything else. The less you need external validation to confirm your internal sense of self-worth, the more free you are from the constraints, judgments and negativity of the people around you. So decide what you want to accomplish and why, and make sure you’re doing it for yourself and not for other people.
2. Understand the system.
It’s crucial to know the rules of the game you’re playing if you want to accomplish a goal within a large, unwieldy bureaucratic system (ahem, perhaps like medical school?). This includes companies, most schools, the government, etc. It’s less important for individual personal goals (like losing weight or learning jiu-jitsu). Let me give you an example. I knew I wanted to have a strong resume for applying to residency. To me, this boiled down to two crucial steps: 1) scoring high on Step I of the boards (taken at the end of 2nd year, this exam serves as an indicator of how well you learned the basic science material of the first two years, especially if your school is pass/fail), and 2) getting at least a few honors grades on clinical rotations. As far as #1 goes, I didn’t waste time in the first two years trying to learn every step of the Krebs cycle or memorize other pointless minutia in order to get a few extra points on my exams. If I was going to forget it in a week, there wasn’t too much purpose in struggling to learn it in the first place. Instead, I focused on understanding big-picture concepts, so when it came to tying everything together for Step I, I had a head start.
For #2, during my clinical rotations I took initiative to understand the expectations of my superiors and what criteria they used to evaluate students. I asked other students who had worked with my residents and attendings how they graded and why. I also decided, ahead of time, which rotations I wanted to honor. For these rotations I jumped through all the hoops and studied like crazy for the shelf. The less crucial rotations, ob/gyn and pediatrics in my case, I “took off,” psychologically-speaking. I was there in body, but not in spirit. I did what I needed to do to take care of my patients and not create extra work for anyone else, but didn’t waste my time or energy trying to impress people. My best shelf score (final exam after each rotation) was 89 (surgery) and my worst was 77 (ob/gyn). Why such a disparity? Because I was working hard on one rotation and not so hard on the other. This approach allowed me to direct my mental focus to where it really mattered. Instead of directing 80% effort all the time and never performing superiorly in anything, I chose to direct 100% effort when it mattered and 50% effort when it didn’t. The total amount of work was the same, but I ended up honoring five out of seven rotations and getting AOA. Not too shabby.
3. Ask for what you want.
If there’s one area where I see bright and goal-driven people selling themselves short, it’s that they fail to ask for what they want. My roommate puts it this way: “I just want to work really hard and hope I get recognized for it” (I love you Julie!). She made this comment in jest, but I see a lot of people who take this approach, literally. It’s one tactic if you love whatever work someone throws at you, but if you like your free time and are more efficiency-minded, why not work hard only when it’s most important and always get recognized for it? Evaluating medical students isn’t exactly a top priority for most residents and attendings, and sometimes you need to make it obvious to them that you’re doing a good job. If I did something really well and my residents weren’t around to see it, I tried to made sure they heard about it. I also experimented with telling my residents that my goal was to honor the rotation, and asked them their expectations of an honor-worthy student. This way, as long as I did what the resident said, he or she was accountable for giving me a fair grade. If I got an evaluation that I thought was unfair, I went into the clerkship office and negotiated to get it changed (I have tons of theories on the art of getting a grade change… I’ll try to cover this in a later post). My goal was not to get more than what I deserved, but to get exactly what I had earned. I knew that the medical school evaluation system was inherently subjective, inconsistent and flawed, and I wasn’t going to let it work to my detriment.
For those of you who are interested in getting better at negotiating but don’t know where to start, let me tell you that it is a learned skill. You need to practice to get better at it. I’m definitely no expert but I always try to practice comfort with pushing boundaries. Start small (negotiating a later check-out time at a hotel, asking for a bank overdraft fee to be waived) and eventually move up to the big guns (getting a grade changed, asking for a raise). Always ask because the worse is that the person could say no. You will be surprised how often people will say yes. I recently got a $260 pair of snowboarding pants for $100 by finding the manager of the store and pointing out a large dirt stain on the leg (which completely came out after one wash). I negotiated a big discount on my car by calling up one dealer while I was at another dealer and asking them to better each other’s prices. Sometimes negotiating will not be worth the mental strain or time (I once spent 4+ hours on the phone with Budget over two weeks in order to get a mistaken $14 charge reversed), but I look as it a learning opportunity. If you don’t ask for what you want, don’t be surprised when no one gives it to you.
I’ll cover more concepts in my “succeeding without really trying” philosophy in future posts, such as how to spend the most time on high-impact tasks for maximum benefit and minimum effort, how to prevent low-impact tasks (aka busywork) from taking up too much of your time, and why the only rules are you ones you decide to follow.
Leave a Reply