The Lancet Student

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James Orbinski’s new book ‘An Imperfect Offering’. James accepted the 1999 Nobel Peace Prize on behalf of MSF and has worked in conflicts in D.R.C, Somalia and Rwanda, amongst others.

What’s in a gut score?

 An interesting perspective on studying, if not medical practice and indeed life itself, from third-year medical student Ohad Oren, from the Technion - Israel Institute of Technology, Haifa, Israel.

Admit it or not, medical students can be strictly divided into two groups, when comparing their self-style predictions. There are the Nobel Laureates to-be, who always seem not to appreciate their academic abilities as they really deserve to. And then there is the confident “surely-another-A” type, whose constant explanation for their lower-than-anticipated results is a probable miscalculation in points counting.

You may guess that I am some kind of exam-grades forecaster. To be honest, in my case it is not as straightforward as that. My self-grade evaluation varies roughly as a function of the grades-rating of the student with whom I am exchanging words. Meaning that his or her average yearly score is somehow spontaneously translated by my latent senses into a unique scale of numbers. And it definitely provides fertile ground for further discussion.

It is actually the former group of students, the self-deprecators, that repeatedly - and enigmatically - challenge my wits. What keeps annoying me most is the following: is it a self-presentation strategy or a genuine personal characteristic, creating their impostor nature? Or perhaps - though it may sound contradictory at first - does it represent a phenomenon with phylogenetic roots, in the form of a beneficial cycle further enhancing the student’s motivation in his or her next tasks?

Whatever the answer to that question, most of the overrated-prone students - yours truly included - are left to envy the wave-like sensation (so they describe it), that accompanies jumping luxuriously tens of points above your gut-feeling grade. A one-time such experience left its mark on me. I later learned that the grade was for a previous quiz, not for the final exam as I had hoped, which reminded me of the profound effect placebo has on our systems.

So, why shouldn’t all of us start using the brainy secretive tactic of intentionally lowering our expectations, so as to safely avoid being dumped by a horrible score?  Perhaps we should even employ it while taking care of patients. After all, too frequently it happens that patients and their families are given “promises” about future recovery, only to be shaken at a later stage, overwhelmed by saddening news.

A sophisticated sword indeed, but a double-edged one, too. That is to say, how can a medical student possibly enjoy the strategy’s various virtues, while slipping away from its deleterious impact on his professional qualities later on? It appears that we must keep in sight, throughout our relentlessly exigent studies, the final and crucial target whose accomplishment led us to choose this field in the first place. Because, when the time arrives for a recently graduated doctor to show accountability, to make tough decisions, and to engage in life-death matters with patients and their relatives, reliability, precision and self-confidence should predominantly take the lead, and become our most intimate partners.

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