Excellent, the New Average

Sometimes we all need to remind ourselves about the light at the end of the dark cavernous tunnel that is the third year of medical student. It can get murky when you are constantly being watched and evaluated and when you learn about what to expect in the near future.

The fourth year has become uncovered and now we are learning about the residency applications and the MATCH.

The cycle starts all over again.

Our third year creeped up on us not so long ago, and now it's starting to feel like it is slowly coming to an end. We are over half-way through and the fourth year discussion has already begun. Over fifty per cent of our class will choose to extend their education by at least one year, during which time they may travel, perform research or work. I am still on the fence about whether I want to take an extra year to sort things out. Medical training already seems so long. And having gone straight to medical school from college, I am accustomed to moving forward non-stop. At the same time, I want to certainly keep my options open and am considering research fellowships or an advanced degree in either public health or education.

Amidst all the lectures about fourth year planning, the Step 2 exam, clinical performance standards and extending medical school by taking a year off- we are learning more about the process involved in applying for residency and the match. The process and timeline remains very unclear and represent a source of anxiety for many third years.

But one thing is for sure, the third year is all about labeling. Our clinical performance is packaged into a one word adjective. You can be any of the following- "Superior, outstanding, excellent, very good, or good." With over 53% of the UCSF class labeled as "excellent," excellent has become the new average. Seriously.

This culture of labels makes me wonder about the utility of such characterizations. First, the entire process is subjective and determined purely based on other's opinions of you. Second, medical students are unique individuals with very diverse backgrounds, opinions and perspectives, who really can't be characterized by a single number or adjective. But despite such issues, we continue to label each other.

To standardize the process, we are evaluated and given a numerical value that reflects a number of fabricated categories that are intended to measure our fund of knowledge, clinical reasoning and patient relationships. In many ways, the numbers marginalize us, and we may even see ourselves in light of the label we are given. The feedback that accompanies the number oftentimes does not always correlate and we wonder what we could have done differently, or if we should do anything differently. There is only so much any individual can change.

The system exhausts me. It's tiring to always think about what others think about you. A number of us (myself included) have decided to make the most of our third year by focusing on learning and taking care of our patients. And in the process, we hope the evaluation will reflect that. But as much we tiptoe around the inevitable evaluation conversations, there really is no way to avoid the unavoidable. It's on all our minds akin to the white elephant in the room. We all think about it and wonder about it. Some of us complain or try to rationalize the process. No matter what, we work hard and hope it all works out.

And last time I checked, there is nothing wrong with being excellent.