How Middle School Failures Lead to Medical School Success

At the end of a long day -- Jessica teaching middle school and Tim teaching medical students -- we settled into bed and began trading war stories.

In between teaching Latin and English, Jessica had tried to calm an upset parent whose daughter got a C+ on a test. The parent's many emails and phone calls bristled with accusations: This low grade would harm her daughter's precarious sense of confidence and self-esteem. Her daughter was smart, unused to getting such low grades, so what went wrong? In the end, the mother's message -- both to Jessica and to her daughter -- was clear: This low grade must be Jessica's fault and the mother was going to do what she had to do to fix it.

After treating patients with sepsis and other infections, Tim ended the day comforting a doctor in training who crumpled into tears after he politely critiqued a mistaken decision. Instead of talking about how to do better for the next patient, Tim and this young doctor had spent an hour discussing her fears that she wouldn't be able to get a good job. Didn't Tim know how stressful this all was for her? Wasn't it clear how hard she was working?

We love teaching and spend most of our time feeling bowled over by the talents of our students. They are idealistic and bound for bright things, and we feel lucky to be able to help them along the way. But when we talk about difficult situations like the ones recounted above, a common theme emerges: The most challenging students (and families) are those who expect success to be automatic, a birthright, something they should achieve just by showing up. To them, education isn't about learning, or about sharpening skills or broadening horizons. It is about the acquisition of straight A's and trophies.

In the wake of these experiences, each of us had been simultaneously and coincidentally trying to make sense of what had happened. "Hey, wait a second," Jess said, leaning over to Tim's bedside table, "you're reading Carol Dweck? I'mreading Carol Dweck!"

Carol Dweck is a developmental psychologist at Stanford University, and Jessica relies on Dweck's book MindSet when she has to help parents understand the long-term benefits of experiencing failure in the relatively safe harbor of middle school. Parents like the one who was upset over her daughter's C+ often try to insulate their kids against these failures by praising their children's intelligence, creativity, and myriad other talents.

It makes sense -- who wouldn't want their kid to feel confident in the face of the pressure to succeed? The problem is that this strategy backfires in the end. Dweck and others have shown that when children try to preserve their parents' perception of their intelligence, they can be less likely to work hard, and less prepared for the inevitable challenges of schooling, and life after it.

On the other side of the bed, Tim relies on Dweck's classic Self-Theories to help medical students preserve their idealism and avoid burnout. In medical school, top students from prestigious colleges come together in the ultimate academic sink or swim -- they face rampant competition and the stresses of life-and-death on hospital wards. Along the way, they realize they can't all be at the top of the class, they have to cope with constant scrutiny and criticism, and they shoulder the stress of illness and death. Amid this, medical students may retreat to the prestige and money of medicine. They can abandon their compassion and fall prey to the much-touted maladies of physicians such as drug addiction,materialism, and well-publicized missteps that hit the national media.

Beyond confirming that we belong together as the biggest geeks in town, our discovery that we are both secret Dweck accolytes is more than just a coincidence. We've actually stumbled upon a sequence of cause and effect, illustrated neatly in the lives of our students. Adolescents who develop resilience in the face of middle school failures develop exactly the kind of skills that will promote success in medical school. Confronted with the rigorous mental and emotional demands of medical school, they are able to maintain their sense of self-worth, and thrive despite adversity.

These are the students who, years later, say they have been through a lot in medical school but still want to change the world one patient at a time. By contrast, the students who come to medical school in a vain effort to earn their parents' approval by earning another 4.0 average and a six-figure salary struggle with the constant critiques and the punishing hours.

Some students and their parents may feel comforted by the platitudes and unearned honors that many teachers are willing to hand out along the way. But these false trophies prevent students from getting the real prizes of education: the resilience and self-worth that lead to grace under pressure, the ability to face adversity with intelligence and equilibrium. In the end, these are the sort of doctors you want at your bedside.

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