Physicians are always looking for ways to improve patient outcomes. Although this goal has no real endpoint, physicians continue to strive incessantly to decrease morbidity and mortality for patients. Atul Gawande, a prominent surgeon and writer, has demonstrated the benefits of learning from other professions, such as adopting checklists from the aviation industry to utilize in medicine. The subsequent use of checklists in medicine had a surprisingly tremendous impact on improving patient outcomes. After reading Col. Chris Hadfield’s book, An Astronaut’s Guide to Life on Earth, I was astounded at the similarities between astronauts and physicians. An astronaut’s journey resonated with my own experience as a medical student, and I believe there are many important principles we can learn to prevent burnout and practice humility.
The pathway to becoming an astronaut, much like a physician, is highly competitive and often takes quite a few turns before reaching the endpoint. Astronauts can spend years of training without ever leaving our planet’s orbit. Every astronaut acknowledges the arduous journey set before them with a real possibility of never participating in a space flight. As a result, astronauts have habitually learned to define their success not by the number of space flights but by the journey on which they embark upon.
Hadfield tells us, “Focus on the journey, not on arriving at a certain destination.” In medicine, our milestones are plainly laid out from undergraduate studies all the way to an attending physician, where all we do is look forward to reaching the next milestone. It is always the next test, next rotation, or next July. When all we see is a never-ending tunnel, burnout starts to manifest in many ways, such as losing motivation or having a negative attitude toward our peers and patients. However, we should start practicing to gaze towards the peak of the mountain and look down at our path and how far we have traveled. Discover satisfaction and gratification in our personal journey. Take time to reflect on our personal goals and our roots. Even writing brief notes for our future selves about our current thoughts and emotions can help us reconnect with ourselves during more difficult times.
Another lesson from Col. Hadfield deals with one of the premier causes of burnout in medical school: the hyper-competitive environment in which we train. The very nature of applying to medical school (and again for residency and fellowship) plays a significant role in hyper-competitiveness. Some medical schools removed grading and ranking entirely to combat this. The controversial decision to switch USMLE Step 1 to pass/fail was praised by some students, but others are now worried how they will stand out among hundreds of students for residency. Ultimately, an overly competitive environment fosters negative behaviors. This same competition is plainly evident in an astronaut’s career where acceptance rates are less than one percent.
Col. Hadfield emphasizes the need for humility to replace the competitive drive by practicing a unique concept: Aim to be a zero. There is a rather humbling mentality associated with trying to be a zero. A great example that comes to mind is new medical students scrubbing in for surgeries. Initially, if medical students try to be overly helpful without knowing the proper procedures and rhythm of the OR, mistakes are bound to occur, and there is a high chance of slowing down the team. However, if our goal is to be a zero, there is an emphasis on observing and patiently learning the protocols and procedures. Over time, we can start to predict the next steps and hopefully be helpful and maximize efficiency. As a zero, we must keep in mind there is always something more to learn from the situation. Humility is often the most difficult trait to maintain in medicine but by aiming to be a zero, we can stay grounded and hopefully increase the chance for our team and ourselves to succeed.
Medicine is infamously known for high rates of burnout for a myriad of reasons (job security, constant documentation, or the arduous training and work hours). As medical students, we should strive to figure out how to combat burnout and prepare ourselves as early as possible. With the similarity in our training and profession, astronauts have practiced unique methods to combat burnout. If we truly hope to bring innovation to medicine, we must aggressively analyze other professions and learn how we can start adopting their successful principles. Certainly, Col. Hadfield’s life as an astronaut provides numerous easily applicable insights at both an individual and institutional level. He sets an impressive example, and his humble mindset is one that we should all strive for as medical students, residents, and attendings.
Denzil Mathew is a medical student.
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