Reno, Nevada, United States
|Photo by Marcelo Leal on Unsplash|
“She is quite weak,” I overheard two senior residents say about one of my co-interns. I tried to tune out the conversation—I did not have enough time or mental capacity to comprehend what being “weak” entailed. I was busy writing notes, answering pages, and placing orders, but I could not help but hear their conversation. The reason for their assessment appeared to be my colleague’s slowness in writing notes and cluelessness about her responsibilities. They concluded that they would not trust her with caring for their family members. It was harsh and disheartening, and I wondered if they ever planned to tell her directly. I finished my own notes as fast as I could without asking for help. I was afraid of being considered “weak.”
Not too long into my internship, I had heard something similar about myself. A co-intern called me, sounding very concerned. He said he heard rumors that I was considered “weak.” He could not reveal the source of the rumors. I asked him how I could improve, and although he was not sure, he said I probably should work harder. I sat in silence. Work harder. Yes, I could most certainly accomplish that. After we hung up, alone in my one-bedroom studio, I imagined the conversation they likely had, talking about my weakness. I had been told that I was too quiet and needed to be more confident when I presented patients. I did not realize that I needed to work harder as well. Having done well in school for most of my life despite being a non-native English-speaking immigrant from a low-income family, this was a difficult message to accept. Engulfed with emotion, I broke down in tears.
I wrote down things I thought I could improve and started to work on them. I spoke with the loudest possible voice I could muster. I arrived to work at 5:30 am rather than at 6 am. I stayed at work until there was no work or follow-up tasks for the covering night team. “Good interns leave no work for senior residents,” I had been told and internalized the mentality. Later, I would internalize all the messages that followed: “Good senior residents leave no work for fellows,” and “Good fellows leave no work for attendings.”
Medical training is quite a wilderness. No one really prepares medical students for what is expected of them. One moment, you are in the classroom memorizing things that can easily be looked up. The next moment, you are on the wards, trying to not to get in anyone’s way but trying to be helpful. By the time you are an intern, you are expected to work at the level of a senior resident, and as a senior resident at the level of a fellow or an attending. You will do all this while having recently accumulated over two hundred thousand dollars’ worth of student debt.
It took a conversation with a good friend from college to realize how unwell I had become despite doing “better” in residency. We reflected on my life accomplishments and work ethic. “Weak” was the last word she associated with me, and I needed to hear that. After our conversation, I learned to not blame myself so readily and to assess situations more objectively. When someone was unhappy with me, I asked myself if I had done the best that I could at that moment. If the answer was yes, I would stop myself from wallowing in guilt and shame. If it was no, then I would assess how I could improve for the next opportunity. Years passed, and I fit into the medical trainee mold well enough to successfully complete residency and fellowship, and became a cardiologist.
When I myself became responsible for supervising residents, I quickly learned that “weak” residents simply did not exist. If a resident was struggling, it was my responsibility to figure out why and to help them. Most of the time, a “weak” trainee was merely unfamiliar with the way things needed to be done. Medical trainees were smart, hardworking, and motivated enough to get into medical school, graduate from medical school, and be accepted into a residency program. Residents who learned a bit faster were not necessarily “strong.” Most of the “strong” ones were in fact more privileged. Some of them had family members or significant others who were in the medical field and had coached them. Some were from wealthy families or had financially stable spouses, and their sole concern in life was to focus on medical training. I truly appreciated the trainees who were able to dedicate their whole lives and attention to medical training. However, others who needed more support could perform just as well—with time, experience, and guidance. We as medical educators need to recognize that and level the playing field. Medical educators from privileged backgrounds ought to learn about the challenges and stories of those with fewer advantages but who have chosen to dedicate their lives to the medical profession.
As an immigrant physician from a low-income family who was once considered “weak,” I write this to say to those from less privileged backgrounds that there is no such thing as a “weak” trainee. We have already accomplished so much in our lives, often with scarce resources and little support. We are resilient. However, resilience does not mean that our superiors get to call us “weak” when they wish to do less work or invest less time in us. When I was young, I did not fight back because I did not know that I was not weak. Now I have vowed to not perpetuate that tradition. I encourage others to reflect on their biases when they encounter a struggling medical trainee. We could unleash so much potential by learning about their struggles and meeting their needs. And what they need most of all is our understanding that they have excellent intentions and are trying their best.
HTET KHINE, MD, is a cardiologist at Renown Institute for Heart & Vascular Health. She also serves as an assistant clinical professor at University of Nevada, Reno, School of Medicine. Dr. Khine studied Biological Sciences at Stanford University and graduated with Honors. She worked for a year as a research intern at Agilent Technologies prior to medical school. She studied medicine at Geisel School of Medicine at Dartmouth College. She completed internal medicine residency at UT Southwestern Medical Center, and cardiology fellowship at UC San Diego. She is a strong advocate for women’s cardiovascular health and medical education.