The Extracurricular Gamble of Medical School » in-Training, the online peer-reviewed publication for medical students
The goal of this series of reflective essays is to help me process new insights and dilemmas I encounter throughout the preclinical phase of medical school. I hope that they will resonate with others and encourage them to share their stories as well. Here, I discuss my preoccupation with my to-do list and hesitancy to decline opportunities for which I lack adequate time.
“You cannot be anything if you want to be everything.” —Solomon Schechter
I remember hearing an important piece of advice: “If you are passionate about something, you will make time for it in medical school.” This advice, however, was soon countered by a snarky follow-up: “It is not that you did not have time for it; you did not make time for it.” After hearing several accounts of the grueling nature of medical school, I agreed that it is important to keep up with my hobbies and interests. There were at least a few activities in college I wish I had done, so I did not want to have any regrets about my M1 year.
Going into the fall semester, I knew I wanted to be involved in health policy and had an idea about how to carry out this interest. When I read about activists in Students for a National Health Program (SNaHP) protesting outside the halls of the June 2019 American Medical Association (AMA) National Meeting in Chicago, I felt inspired to organize a chapter at my school. SNaHP is a student branch of a grassroots-minded activist group whose aim is specifically to mobilize medical students in favor of single-payer universal healthcare.
The AMA is an industry trade group of physicians that has opposed nearly every major healthcare reform for the past century and is staunchly opposed to single-payer; despite AMA’s opposition, however, the Medical Student Section (MSS) strongly supports it. I viewed the two as different, but necessary, avenues to meaningfully move the needle toward health justice, and I pledged to devote a significant amount of my time to both.
However, I did not realize how much time my coursework would take, let alone extracurriculars. The unorthodox format of the curriculum and massive amount of information were unlike anything I had anticipated. At the same time, I was discovering that the policy papers would not write themselves, nor would the PowerPoint slides, the panel questions or video scripts.
As the weeks progressed, I began to notice an intriguing contrast: the often zoomed-in topics such as metabolic pathways or antibiotic mechanisms of action versus the zoomed-out topics such as vaccine distribution or racial health disparities. My work in SNaHP and AMA would remind me of the big picture and the reason that I would spend hours every day pouring through lecture notes or repeatedly hitting a spacebar.
In those moments when I checked off everything on my agenda for the day, I would feel whole and content. In many ways, I would not trade my extracurricular experiences for more study time, largely because of the community I had built with like-minded peers both in and out of school.
It is not the moments I spent memorizing types of bacteria or skin lesions that I will particularly remember; rather, I will remember the time I delivered oral testimony for a resolution I spent two months writing and refining, the time I had a fascinating book club discussion with my friends on the history and philosophy of psychiatry or the times I co-facilitated resilience sessions for high school students on mindfulness and purpose. Provided I passed my modules, the work I put into them felt more than worthwhile for the depth they added to my medical education.
My synergy between school and clubs was not completely rosy though. While my to-do list may have been checked off for the day, I did not always feel satisfied. Stress from extracurriculars can manifest as a unique nagging feeling because the deliverables seem up in the air. The work is never fully done. With extracurriculars, it was not as simple as having a goal to read a set number of pages or do a set number of questions. I frequently told myself that after the next benchmark or after date X/Y/Z, I could relax and take a step back, but it never turned out that way.
There was always one more item to follow up on or to keep in the back of my mind. Undoubtedly, my extracurricular activities take precious time away from studying. Although I satisfy all my course requirements and am in good standing, I often find myself struggling with basic competencies such as not knowing which medications to administer during a mannequin-based simulation exercise or forgetting the types of epithelium in a histopathology lab.
I cannot help but think how my abilities and confidence would be at this point in my M1 year if the time spent on clubs were used for doing Anki reviews, board prep material, or just taking time for myself to relax more. My recognition of this opportunity cost is not “whataboutism” or “being hard on myself,” only a necessary acknowledgment for me to move forward.
I describe my involvements not to flaunt, but to forewarn. In hindsight, I pushed the “make time for your passions” mantra to the extreme, often working on outside tasks during prime study hours on weeknights and, in general, setting aside too much time for non-school items at the expense of my academic performance.
In other words, I was partaking in a gamble — a gamble of balance. I could be a knowledgeable and competent, socially-conscious and action-oriented, physically and mentally healthy medical student, fulfilling each domain without detracting from another. Yet, what good is structural competency in the many social determinants of health, if I as a future physician would not be able to carry out my primary duty of providing care to my patients?
It is hard to say how the residency application process will pan out for my class without a numerical USMLE Step 1 score in hand, but I imagine that all other components of the application will have inflated importance, including creative outlets. But it is possible that extracurriculars could hinder my residency application even if they are deemed to be genuine, non-superficial endeavors. Some programs may view them as a liability or proof that I am too easily distracted and not serious about the profession.
It is my responsibility to prove them otherwise by verbalizing my goal to become the best physician I can be while also retaining my humanity and inner-flame, thus finding a sustainable system of self-care. This exercise no doubt requires introspection about the degree to which I can stay committed to social justice issues I care deeply about, accepting that it is okay if I cannot devote hours to each one.
When I think back to images of those white-coated medical students protesting in the windy city, I wonder how many of them experience similar internal strife as they strive to do best for their future patients, both by fighting for healthcare as a human right and by mastering the fundamentals of clinical medicine. I do not know the ideal ratio of time to spend on each pursuit, but I know a zero-sum game is in play; something has to give.
Yes, I must keep the big picture in mind and not sweat the minor mishaps, but eventually, those add up and the big picture becomes a giant blur. I certainly have not missed the forest for the trees, but perhaps I have missed the trees for the forest. Now is the time to recalibrate and focus on what is in front of me: medicine.