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How competition is damaging my profession and making us less proficient

Submitted by PerfectSociety in Education

Growing up in a capitalist political economy, most of us are aware of the cultural belief that competition is crucial for quality - that it brings out the best that people have to offer. In the context of a market society, it certainly makes sense that such a view would become ingrained into our culture.

However, I think we often fall victim to a confirmation bias with regard to this belief - we remember instances in which competition seemed to have improved something while forgetting or not even realizing the various instances in which it has made the quality of something worse.

As a medical student, competition within the field of medicine and its impact on the quality of healthcare is something that has been on my mind. I am in the latter half of my medical school curriculum, during which I am arranging electives and sub-internships in fields related to my choice of specialty.

During this process I have noticed how the methodology in which students select these electives and sub-internships is based primarily on which ones they can earn a good letter of recommendation from, rather than based on selecting those which help us strengthen areas that we are weak in that are related to our choice of specialty. For example, if a medical student is not very good at picking up and interpreting heart murmurs he/she will avoid doing a cardiology rotation (which is literally the best opportunity to improve such a deficiency) out of fear of not getting a good enough evaluation. The concern is that a mediocre evaluation in an elective rotation will make the him/her less competitive as an applicant when applying to residency (https://en.wikipedia.org/wiki/Residency_(medicine)) positions.

Consider for a moment how absurd this is: There is a strong incentive for people training to be doctors to consciously avoid experiences that would address areas in which they are sub-par or clinically deficient, in order to get a good evaluation so they can be competitive applicants for residency training programs. And this is during the most critical time in which these soon-to-be doctors have the best opportunity that they will ever have to work on their areas of weakness. After all, once they start practicing they will no longer be able to devote attention to improving their clinical skills as much as they would be able to as students (when that is their full time role).

As I reflected more on this issue, I realized that this avoidance problem was not just prevalent in how students pick their clinical electives and sub-internships. It is also prevalent in Core Rotations: the foundational clinical curriculum that medical students undergo to build a base of clinical capacity prior to electives and sub-internships.

Students would often avoid or be hesitant about taking challenging patients for whom they could not feign expertise regarding clinical management to their senior evaluators. Additionally, students would often make a conscious effort to avoid drawing attention to their areas of weakness out of fear of impacts to their evaluations.

Having discussed this with my fellow students, it became apparent to me that if it were not for this competitive grading and application process they would actively seek out opportunities to improve their clinical skills and tackles areas of difficulty. They would take electives in areas they need to improve on and try to use this time we have as students for education that addresses our areas of weakness, rather than trying to avoid them out of fear of mediocre evaluations.

To me this seems to be a clear area in which competition is doing far more harm than good.

I'm curious if anyone else has had similar experiences in the area of education or otherwise?

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2

Paprika_Luna wrote

That reminds me of some other schooling criticisms, particularly along the lines of "learn the test, not the material." In fact I think the issue is the same: people seek the 'goal:' a high number at the end, a glowing review or evaluation, a job, whatever. It seems in many cases there's no real choice otherwise. "Get good grades or you're a failure" leaves more room for trouble than people care to consider, even assuming it does result in better 'results:' that there's a number assigned to it doesn't imply that the number describes it, let alone encapsulates all that needs to be known about it. When "it" is a soon-to-be doctor's medical proficiency? I sense problems.

Yet more garbage that goes unquestioned... :-\ Maybe it's a love of simplification, especially down to some sort of rating. Maybe it's some kind of competition fetish. Maybe it's these and more. I can't really give a complete solution but I certainly see your point that people should be encouraged to improve rather than encouraged or to whatever degree required to avoid letting anyone see that they need to.