director of the Problem-Based Learning curriculum at the UC Berkeley-UCSF Joint Medical Program, and codirector of the Foundations of Patient Care course and the Health Professions Education Pathway to Discovery Program at the UCSF School of Medicine. “I think the key in advising students about all the complexities that go into making a big choice such as this one is to listen first. Do your best to understand where the challenges and blind spots lie for each individual trainee, and then help them see those relative weak spots from a new vantage point. “Of course, I’m not giving them specific answers to the choices—I don’t say, ‘You should go into psychiatry.’ Instead, it’s more about pointing out the dilemma that the student may not quite fully understand him- or herself: ‘It seems to me you’re struggling between a lifestyle choice and something you seem really passionate about.’ From there, as it’s ultimately the student’s life to live, I leave it in their own hands to decide what seems right. “Lastly, I offer a general piece of advice that was once given to me when I was applying to residencies. You know how animals have their fight-or-flight instincts? Like gazelles on the plains of Africa whose ears perk up when they sense danger because a lion is lurking nearby in the grass? As humans, we too have that same paleocortex of our brains—we just tend to suppress it under the guise of intellectual superiority. But it’s there for a reason, and we should not ignore it. When deciding a specialty choice or getting on the interview trail, you’ll get those gut instincts that tell you that a certain career or place just isn’t right for you. Even better, you’ll get that gut instinct telling you that you know you’d be happy. Trust those instincts—they’re your heart talking instead of your head. And we in medicine tend to make the error of following our heads and ignoring our hearts far more than we should!” Calvin Chou, MD, PhD, FAACH, is an associate professor of clinical medicine at UCSF, the codirector of the Foundations of Patient Care course and the director of the V.A.-based Longitudinal Rotations
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(VALOR) program at the UCSF School of Medicine. “There are a couple of important principles that I hope students hear and try to remember: “First, career choice occurs in the context of your entire life. Don’t oversacrifice your life for your career—few people in the twilight of their lives say, ‘I wish I’d worked more.’ But at the same time, don’t fritter away your life in front of the TV when you can gain such fulfillment out of the work of medicine. Unlike many other professions, we are extremely lucky that the basis of our work is to help others through some of the most trying periods of their lives. “Second, identify your passion—your vocation—as well as possible, and let that lead you through your entire career. I know it’s kind of touchy-feely to say to always know your true north, but it is completely true. I can say this as the poster child for someone who changed career paths: I was an MD/PhD student with a thesis in molecular immunology, and along the line I was brutally honest with myself and realized that running a lab and thinking about molecular biology—while fun—was not my true passion. I am interested in how people talk to each other and want to facilitate deeper understanding between people, be that patients and doctors, learners and teachers, colleagues, etc. Always remembering that keeps me on track for my career. I know people that I’ve advised in the past who let other considerations get in the way of their passions, and they become unhappy or jaded. Life’s too short for that. Why not make work a passionate experience?” Tim Kelly, MD, is an HS clinical professor, vice-chair for Education as well as the director of Advanced Clerkships and Intern Selection at the UCSF Department of Pediatrics. “I often counsel students to think not just about the patients that they will take care of but also about the people they’ll be surrounded by in the discipline or specialty. For instance, I loved my OB mothers—delivering kids, miracle of life, spiritual moments for sure—and found it very rewarding. However, I found the OB nurses to be a bit pushy and cranky out
of sheer necessity to get the job done, I think, and they were clearly better than competent. “But when I got to pediatrics, it just felt like home. These were my ‘peeps.’ They were funny, caring, casual, lighthearted, deeply passionate about kids. My colleagues-to-be weren’t afraid to sit on the floor with a kid to make a connection or get peed on by a baby with great aim (and then just laugh about it—almost like it was a privilege—and not get ticked off about it!). They were sort of how I saw myself, or at the very least what I wanted to be and aspire to in my professional life. I usually have students reflect on what moved them and spoke to them at a broader, higher level than just the actual focused work—like the environment and the people surrounding them. “I also have students imagine what it would be like at the worst (or most challenging) time in a career: It’s 4 a.m., you’re tired, stressed, asleep in your warm bed on a cold, rainy, blustery San Franciso night and you get called to come in to the hospital for something that is undeniably essential—no wiggling out of this one. You drag your sorry butt out of bed and you shuffle over to the mirror to get dressed and you look at your reflection and say, ‘I am going into the hospital to see . . . fill in the blank.’ What do you get? How does that sit? Are you ticked off and hypercritical, nasty even? Or are you able to be (somewhat) compassionate and (somewhat) excited by what you are about to do? If so, then that is the specialty for you. This exercise is imagined in the future, when you are done training and not a resident—what your life might be like for decades. I can honestly say that for me, when I say, ‘I am going to see a sick (abused) (in pain) (scared) (specialneeds) kid’ in those darker moments, I am as thrilled today to contribute and to heal and to make a difference in their little lives as I have always been.” Perhaps what is most important to remember in choosing a medical specialty is that career decisions can happen many times over the course of one’s life, spanning work and nonwork domains. Thus, Continued on page 21 . . .
October 2010 San Francisco Medicine 19