“Our specialty is not specializing”

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Having recently turned in my first-year summative portfolio (what we do at the Cleveland Clinic Lerner College of Medicine [CCLCM] in lieu of exams and grades), I can’t help but reflect on how this unique system of evaluation has changed my outlook and afforded me tremendous growth during this first year of medical school. “No exams and no grades?,” people often remark when I explain our curriculum, “Sounds like a pretty sweet deal!” While the true ways in which this system is “pretty sweet” may not be so apparent on the surface, they are many-fold and offer insight into what may be a much more fulfilling approach to life (once the initial discomfort is accepted, of course).

From a very young age, I, like many others, have been conditioned to strive for perfection. Whether in school trying to please teachers and earn perfect grades or at gymnastics practice performing movements over and over again so that my routines might score just a tenth of a point closer to a “perfect 10,” I always focused on the most minute details to be sure that I gave my best effort in every endeavor. I thought that as long as I studied hard enough or practiced long enough, “perfection” would be within my grasp. While this approach did me well in the sheltered environment of my primary school years, once set loose into the real world and exposed to the vastness of knowledge and possibility, I quickly realized I had neither the time nor the energy to embark upon such a comprehensive quest for perfection in each avenue I wanted to explore. Because in college grades provided the single most visible measure of my abilities, I began to channel my perfectionist tendencies toward my transcript. Trying to hang on to the possibility of perfection by dedicating myself to this single endeavor with such an important outcome, I would often find myself settling for a less-than-perfect effort in other areas such as extra-curricular activities or spending time with friends and family. As each semester passed and the amount of information to learn and assignments to complete continued to grow exponentially, I also found myself losing touch with the pleasure of learning for the sake of learning and sometimes even sacrificing my own true understanding of material in pursuit of perfect grades. However, these grades provided a false sense of satisfaction – though I walked away from many an exam feeling confused and defeated, upon receiving a grade I considered satisfactory I never again considered returning to my books to clear up my previous qualms – I was too busy studying for the next exam to earn the next grade. Perhaps these grades, in addition to disproportionally shifting my efforts toward only one aspect of my life, masked many of my weaknesses and hindered me from making further improvements.

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What’s in a grade, anyway?

Enter medical school: no grades, no exams, and the analogy “drinking water from a fire hose” could not be more true. The amount of information to learn, shadowing and volunteer experiences to be had, and research projects to conjure up seemed endless from day one. Students who have been conditioned to strive for perfection their entire lives are suddenly overwhelmed with the impossibility of learning it all, and gone is the opportunity to feel even a slight sense of validation for our efforts by earning an “A” on an exam. However do these type-A’s cope with such a situation? From my experience, the answer lies in gaining comfort with recognizing and unmasking our weaknesses and in acceptance that balance across many domains trumps perfection in just one – a.k.a, the portfolio system.

Instead of the traditional system of exams and grades, the CCLCM implements a portfolio system in which students evaluate their own progress in 9 separate competencies: research, medical knowledge, communication, professionalism, clinical skills, clinical reasoning, personal development, health care systems, and reflective practice. Incorporating feedback provided by faculty and peers throughout the year, we assess our progress toward achieving the standards in each of these competencies and devise realistic strategies for making improvements.

In the above description, you will notice that medical knowledge provides only ONE of the 9 competencies in which we are assessed. The portfolio system recognizes the equal importance of each of these areas in the development of physician researchers and does not allow us as students to neglect any one in exchange for deeper pursuit of another. Sound familiar? CrossFit also recognizes that in order to achieve optimum physical competence, one’s ability must be distributed evenly among “10 General Physical Skills” – cardiovascular endurance, stamina, strength, flexibility, power, speed, coordination, agility, balance, and accuracy. We concede that as CrossFitters we may not achieve the level of stamina displayed by an Olympic triathlete or the strength of a world-class powerlifter, but we are willing to make those sacrifices in order to maintain balanced physical abilities. In much the same way, as physician-researchers-in-training, we recognize that we may not have the degree of knowledge in any given subject area as a Ph.D. researcher or the understanding of health care systems of health policy makers, but we are willing to sacrifice striving for such a degree of perfection in any one of these areas in order to be competent in the many areas that allow us to successfully care for patients and improve the field of medicine. For individuals conditioned to strive for perfection, this is not an easy task at first – it requires us to step back and evaluate our goals.

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The CCLCM portfolio system and CrossFit – recognizing that balance across many areas may be better than perfection in just one

Could I be better at Olympic lifting? Yes, probably, if I spent all of my time practicing Olympic lifting. But what is my goal? My goal is to achieve optimum physical competence, therefore I cannot afford to spend all of my time practicing Olympic lifting while neglecting development of other areas such as endurance and stamina.

Could I achieve greater breadth and depth of medical knowledge? Absolutely, if I spent all of my time pouring over my textbooks and memorizing every word. But what is my goal? My goal is to become an excellent physician researcher, so my medical knowledge will be useless if I have not also developed skills such as communicating with patients and clinical reasoning.

Additionally, you will notice in the description of the portfolio system that gone are the days where our shortcomings can be hidden behind the outcome of a stellar grade. In this system the façade is removed and we are all forced to address our weaknesses. We are required, even rewarded, for identifying the areas in which we need to make improvements and then acting on them. This notion is one that society frequently shies away from. Constantly pressuring individuals to exude an air of perfection, society persuades us that the perfect outfit or a stellar college transcript, house, or career can provide a façade for the imperfections and insecurities that we all have. While they may allow us to proceed through life smiling on the outside, outward expressions of perfection may actually prevent us from recognizing our flaws and capitalizing on real opportunities for growth. In a similar way to the CCLCM portfolio system, CrossFit also acts to eliminate façades of perfection, giving individuals the opportunity to be vulnerable, to explore their weaknesses, and to learn from them in order to become better athletes all-around. The beauty of CrossFit is that it cannot be bested by our fancy façades – no matter who you are, how much money you make, or what kind of clothes you are wearing, CrossFit will force you to come face-to-face with your imperfections. In so doing, CrossFit allows us to conquer these weaknesses that we otherwise might have shrugged off, avoided, or kept hidden to ourselves. By calling our bluff – exposing weaknesses in the gym and showing us that it is possible to make improvements, CrossFit empowers us to extend this behavior to other aspects of our life. And though we may feel vulnerable at first, identifying, rather than ignoring, our shortcomings and taking steps to overcome them paves the way for an exponentially more fulfilling life.

My first year at the CCLCM has reinforced the concepts that CrossFit teaches me every day. The portfolio system reminds me that “perfection” in life is defined by our own personal goals, and sometimes balance across  many competencies IS the perfection we strive for. As our goals shift, so does this “perfect” target, such that we are in constant pursuit of betterment. Additionally, I am assured that though incredibly uncomfortable, true growth is possible only by stepping out from behind our façades of perfection to grapple with our weaknesses. In doing so, we gain strength in our shared struggles and the impetus to work toward the goal of becoming better human beings.

“Our strength grows out of our weaknesses” ~ Ralph Waldo Emerson
  • Brady

    very interesting. i would also argue that the value of any such knowledge is limited by the ability to put it into practice. “memorizing every word” is useless in a field study if the practitioner is unable to put it to use. Such is the problem with many PhD candidates; while they look good sitting behind a desk, their impact is limited due to not developing the next phase of their training, i.e. presentation. Developing skills across areas not only allows one to become well balanced, but increases the skills necessary to utilize the area of intended concentration to the highest degree.

  • Omar

    Such great insights. I have been in a “love-hate” relationship with science and the pursue of a Graduate Degree during the last few years. This largely due to the imposition of academic standards and many “traditions” that -I believe- actually hinder the progress of science (instead of enhancing it). So, it is really inspiring to hear of new approaches to education such as the CCLCM portfolio.
    On the CrossFit side, as a 30 year old guy with not much athletic background and/or history, it has certainly been an amazing window to get to know myself better and inevitably translate many of the gains towards most areas of my life. It has been a valuable tool and “path” in the pursue of balance.
    Thank you very much for taking the time to share your insights and communicating them so clearly!
    All the best to you in Medical School and the CrossFit Games, greetings from Guatemala, Central America :)

  • Wesley Kosko

    I couldn’t agree more with your essay/blog. It is important for a healthcare professional and CrossFit athlete to be well-rounded and balanced. I just finished up my second year of pharmacy school; our school doesn’t have anything remotely close to CCLCM’s portfolio system. I have encouraged my fellow peers to become more active outside of the classroom to participate and further their education of practice of pharmacy. I would like to propose something comparable to CCLCM’s portfolio system to the deans my pharmacy school. Thank you and keep up the great work and good luck at the 2012 CrossFit games.

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  • 42elysium

    Well said Julie. Your insight is spot-on. There seems to be this undercurrent of selfishness, greed, jealousy, and blind ambition which fuels our desire to pursue perfection. I’ve gone down that path and it has been for naught. I believe the CrossFit community has done a superb job in highlighting those who have paid the ultimately price in serving others. That’s really the secret I have found. It’s so much more rewarding to give of ourselves in the pursuit of bettering others. The result is that we are more fulfilled. Thanks for your thoughts and for the example that you set in your field of medicine and on the CrossFit champions circuit. I wish you the best this summer. You’ve challenged me to write about this topic. I called my post, Desire. http://phonicmatrix.wordpress.com/2012/05/30/desire-47-2/.
    -Mark

  • http://eisparklz.blogspot.com eileen

    Extremely well written blog. Thank you Julie, for sharing your insight. You have somehow captured the exact reasons why I began crossfitting – I was very good at being perfect at everything, and crossfit exposes my weaknesses and forces me to challenge myself every day. I’m looking forward to future thought provoking posts from you. Good luck in your next semester and the games!

  • Petra

    What happens to people who fail in one or multiple categories? For me, this is the ultimate test of any education system…

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  • christyphillips

    I enjoyed reading your post. Both the CrossFit community and medical community are lucky to have you, Julie!

  • lunden

    Julie, this is amazing and very true! I am very familiar with the struggle of practicing to perfection and I think this is just one way CrossFit has improved me. I met you and your parents at Central East Regionals and will never forget that experience. You have given me the drive for success and the hope to keep striving. I am thankful for the opportunities to make myself better athleticly or accademicly. Good luck at the Games!

  • http://gravatar.com/rachelwilsonbeauty rachel wilson

    This is great! I really identify. I always struggle with wanting to be the best at everything. It seems like the world wants you to pick one thing and stick with it, but I want to experience as much as I can in life. I have too much ADD to ONLY do ONE thing. That’s the best part of Crossfit!

  • Jessica Lopez

    Couldn’t agree more!!! As a division I college athlete, I struggled trying to be “perfect” in both academics and athletics. Not to mention, being a science major made it tougher trying to achieve that goal of perfection while all my teammates had less demanding majors and more time for our sport. I finally found out that being perfect in one meant sacrificing time and energy in the other. I couldn’t give all my full attention to my sport because in order to be a, key word, COLLEGE-athlete, you have to maintain good grades as well. As much as I wanted to be perfect, I finally realized that being balanced in both academics and athletics is what made me more content. Thank you for your insight. I look up to you as an athlete and future grad student. Congrats on your Crossfit win and good luck in med school.

  • http://www.facebook.com/paul.odonnell.96199 Paul O’Donnell

    Super articulate and insightful. I was rooting for your to win it all but once it gets heavy Annie is tough to beat. Thanks for your thoughts.

  • Presley

    Julie,

    I do not know how many times i read this post for motivation! I am now a sophomore in high school and strive to be the best that I can, both in academics and crossfit. You gave me a role model that is a full time college student and still one of the greatest crossfitters in the world. Now I know that it is possible, my dream is to go to Michigan state and get my masters in epidemiology. Also to be the fittest woman on earth! If you are doing it then hopefully I can too! I have you to thank for everything and the sport of crossfit. From the bottom of my heart thank you.

    Presley Cruz

  • Sandy

    Petra –
    Under-performance in an area of competence at CCLCM can result in one of three things, depending on the degree of “failure” – first is remediation, where a formal plan is agreed upon to catch the student up in their weak area (this is generally going to be required extra work and required extra evaluation, on top of continuing to keep up in all the other areas). The second is repeating a year, and the third is leaving the school entirely. The school’s not very old (there have only been 4 classes of students graduate so far), and each class has a few people who go on remediation at SOME point, and I think most classes have had people take an extra year to graduate (though most of those are for things like illness or an extra year of research), and I think there’s only been a couple students leave completely (and I don’t know if it was forced on them because they were incompetent or not).