Vera N. Guertler, MD

No one would argue that constructing a solid foundation of knowledge based on a core curriculum is the primary aim of medical school education. However, knowledge is only half the equation; a successful student of medicine must also know how to apply that knowledge. I often liken this dichotomy to the didactics and practical component of driver's education. Education can pave the road for a smoother transition to medical practice by emphasizing the acquisition of certain "driving skills." Equipping students early to make good decisions could avert being burned later.

On the road to good practice, four vital skills deserve heightened attention:

• There is value in sharing the road.
• Expect the unexpected.
• Beware of distractions.
• Read road signs carefully.

While learning to steer, remember to share the road. In other words, be part of a team. This is a teachable concept, if modeled appropriately and sufficiently. Too often, competitive traits rule rounds, where hazing and belittlement by those in power foster one-upmanship. Entitlement ensues, with the equivalent of road rage often following on its heels when stress rises in the workplace. If medical faculty instead cultivate a team approach, it would better mirror the improved outcomes patients derive from multi-disciplinary approaches to complex conditions.

If medical students are permitted to draw on each others strengths and weaknesses (and not just draw blood), they may be more inclined to respect and not openly denigrate (sometimes in front of patients or attorneys) differing practice styles of colleagues. Too often, physicians are subject to the "divide and conquer" tactics of attorneys and administrators at our own expense. Where does it say that unifying physicians should be on par with herding cats? Medical students could be empowered to accept different perspectives. Especially in difficult cases, educators should encourage students to "think outside the box," before passing judgment, and even listen to "fresh takes" from ancillary staff, often on the frontline with patients.

Second, it is vital to prepare medical students to expect the unexpected. There are no cookbooks for careers. Long-term single-shingles are a paucity. Still, many physicians see it as a sign of failure if faced with the prospect of changing practice locations or arrangements. Nevertheless, changing practices may be the healthiest alternative: similar to acknowledging that you have taken a wrong turn on the highway. Instead of denying or hoping that the landscape will soon change, it is important to get back to the main road and move on.

Within this context, medical students need to be encouraged to cultivate flexibility and conduct self-inventory with respect to one's own strengths and weaknesses. Know when to ask for help. Some may acknowledge a higher power for this purpose. Likewise, there is value in learning to take a spiritual history of our patients. In light of unpredictable events, scattered support systems, and thinning financial means, patients often benefit by physicians acknowledging their spiritual needs. Such validation does not need to be limited to only the province of palliative care. Devoting care to these details can open the door for patients to ponder advanced directives without defensiveness. It is part of the art of communication that aligns healers and patients in a partnership, which can also lessen the likelihood of future malpractice allegations.

Additionally, another practical pearl that needs emphasis is to beware of distractions. Medical students delay "having a life," and thus, upon release, some rush headlong into personal and professional dead ends. Sources of derailment include not just easy access to substances and subsequent impairment, but also, sudden availability of financial resources. Many rush to acquire status symbols and therefore, crippling debt. Also alluring are addictions to food and false intimacy, along with the ever sanctioned work-a-holism. These actions ensure that physicians have a higher rate than the national average of alcoholism, divorce, and suicide.

Educator alert: if we do not take care of our own, who will? Addressing these vulnerabilities early on is the first step to prevention. In medical school, discussion and action need to be taken to devise alternative methods for de-stressing. Sponsoring support groups for students is a place to start. Indeed, active mentoring of students is invaluable. Present alternatives to those distractions that could drive one off the road. For example, engage students in community service participation such as soup kitchens or mobile van clinics. Also, often organized outdoor outings can be a source of balancing the body with an overworked mind. What good is the making of a great doctor, if lacking stress management skills, one implodes like a bright light into a black hole?

Finally, learning to read road signs is a valuable tool for medical students. This skill is especially applicable to negotiating contracts and being shown how to navigate around the business end of medicine. Hitherto, a veritable paucity prevails in teaching students to market their skills and make the most of their clinical expertise. The world no longer operates on "gentlemen's agreements."

One must know the nomenclature of non-compete clauses, practice buy-ins, and balancing overhead. Or at least be adequately introduced to business concepts. Trial and error in these subjects is costly, and ignorance does not pay. Recruiters bank on physician naivetÃ©. If some offer sounds too good to be true and involves heavy wining and dining, pull over and read the fine print with an attorney's lens. It is worth wondering: if this position is so plum, why does it not sell itself?

The experience and knowledge gleaned in medical school set the course and coordinates for a student's future career. In this ever-changing landscape, no longer are physicians viewed as patriarchs who alone call the shots. Students need to experience the value of collaboration, not criticism, between different facets and fields of medicine. Learning to work as a team should be keenly emphasized by faculty educators. Also, medical students need to be prepared to expect the unexpected, including how to handle competing pressures. Healers cannot heal themselves, nor should they be taught to deny their basic needs. Otherwise, they, indeed, become more vulnerable to distractions as quick fixes. These ruts in the road ultimately generate more internal friction leading to disconnection with self and society. Furthermore, future physicians need some introduction into negotiating the busy intersection of medicine and business.

For our medical students on the road to "terra nova," remember the Chinese proverb: "To know the road ahead, ask those coming back." Being well-equipped is key. The teachable skills of teamwork and flexibility must be modeled by those entrusted with the astounding privilege and responsibility to educate future physicians. We must all invest in validating, sharing wisdom, and empowering our successors to reach their full potential.

MD is a board-certified family physician involved in occupational medicine and urgent care. She enjoys public speaking, publishing poetry, and exploring the frontiers of transcultural and mind-body medicine. She can be reached at 

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Driving skills: learning to navigate the road to a successful medical career