The Negative Effects of Competition Amongst Medical Students and 5 Tips to Overcome Them

Dec 2, 2014

During a typical day in the third and fourth years of medical school, students work with countless other students. For example, on any given clerkship I work with anywhere from 0 students to 6 or more. So what happens when you put multiple medical students in a setting where we are all vying for clerkship grades and letters of recommendation? The obvious answer is competition. On many levels competition can be very useful in pushing everyone to be their best. However, many times it can get out of hand and there may be negative consequences. Every medical student has heard of the story of the “gunner” who gets to the hospital earlier than anyone else and takes all of the patients for their benefit. The question then becomes what kind of student outcomes exist in these settings of competition?

Competition among medical students can lead to many poor outcomes in medical education and patient care. Unfortunately, in the medical setting, there is a long documented history of students cheating or falsifying information. One review found that up to 58% of medical students admit to cheating (Kusnoor, 2013). Cheating on the clerkships often manifests itself as falsified information regarding work that students performed. This often includes listing parts of the physical exam and history that were not actually obtained or assessed by the student. Medical care can be disrupted at any level if a reporter gives this false information, and the mistakes can be costly. Students list multiple reasons for making these false reports. Responses usually come down to two main themes: Fear and Praise. I will be the first to admit that on rounds there can be a sense of fear that as students we missed something that we probably should not have missed. I will also say that nothing is better than being praised for something that you did find or assessed correctly. Both responses truly come down to ego, not wanting to be wrong or uniformed, and wanting to be praised for being correct or informed.

Another study published in Academic Medicine reported that a large decline in empathy has been noticed among medical residents and students (Neumann, 2011). Their review suggested stress and “burnout” as the key determinant of decline. They indicated that among multiple studies burnout and stress lead to inappropriate behavior, cutting corners, and an overall decline in showing empathy to the patients (Neumann, 2011). Burnout among residents and medical students is in no way a new topic and has led to many negative patient outcomes in the past. While many administrative and legal changes have been made to try and decrease stress and burnout, increasing competition amongst students is likely to contribute to student burnout.

Moving forward, it is important for institutions, both schools and the hospitals students practice in, to try and decrease competition for better medical education and patient care. Here are my five tips for cutting back on competition on the clerkships:

  1. Work as a team.Medicine is not a one-person effort and working together can greatly benefit your own learning and patient outcomes. Health care is moving increasingly towards coordinated care models, so you should start by viewing your peers less as competition and more as colleagues.

  2. Don’t falsify information. It is ok to admit you missed something or forgot to look something up. A good response to not having the information is, “I will make sure to look that up next time”, or “I can go check on that now”. While this can feel like failing it is actually more impressive to admit your faults and gather correct information as opposed to falsifying information.

  3. Treat everyone with respect. While this seems to be inherent to any practice it is amazing how often people on the medical team must be reminded of this. It is key for medical student learning and patient outcomes that all members of the team treat each other with dignity and respect.

  4. Prevent burnout. Remember to find time for balance in medical school. This applies to any year of school and not just the clerkship years. Burnout has a huge correlation with competition and falsifying information,so staying happy and keeping a positive attitude can go a long way in decreasing competition.

  5. Have fun, and take what you can from every clerkship. Aim to do your best in each clerkship, regardless of whether you want to pursue that specific field. Each of the different aspects of medicine has something it can teach you for your future practice. Enjoying yourself while learning about the different areas of medicine will not only decrease competition, it will also lend to greater learning.

References:

Kusnoor, MD, Anita V., and Ruth Falik, MD. "Cheating in Medical School". Southern Medical Journal. 2013; 106 (8): 479-483.

Neumann, PhD, Melanie, Edelhauser, MD, Friedrich, Tauschel, MD, Diethard, Fischer, MD, Martin R., Wirtz, PhD, Markus, Woopen, MD, PhD, Christiene, Haramati, MD, Aviad, and Christian Scheffer, MD, MME. "Empathy Decline and its Reason: A Systemic Review of Studies with Medical Students and Residents". Academic Medicine. 2011; 86 (8).