As we near the height of the holiday season and the stresses of travel or juggling extra obligations, it is all too easy to fall out of our normal workout routines. It’s important to stay active amidst this chaos, and that’s exactly why I partnered with Beyond the Whiteboard to create TRAIN On The Go. One- or two-week programs feature workouts that can be done anywhere with no equipment. Pre-programmed timers keep you on track from warm-up to cool-down and all sessions can be done in less than 30 minutes, leaving with you with time to shower and make the party on time!
To check it out, head to Beyond The Whiteboard and scroll to the bottom of the page under “Athlete Plans.”
Be sure to tag #TRAINOTG so I can share your holiday workout posts.
Cheers to prioritizing our fitness this holiday season!
Growing up, my mom would often tell me “When I was ten, I broke my ankle taking a giant step in the backyard playing a game of SPUD. Heck, if you can break your ankle taking a giant step, you might as well go out and do something more fun.” Fortunately, she has supported me through many such fun experiences over the years. But, like most parents, she has also instilled in me the fact that there is a certain amount of risk associated with doing just about anything in life. The responsibility falls on each one of us to evaluate and decide how much risk we are willing to take on in order to reap the potential rewards of our actions.
I have become increasingly familiar with the concept of balancing risks and benefits through my medical training. Though every medication comes with a laundry list of side effects, and there is risk with “going under the knife” for any surgical procedure, these treatments regularly save lives and reduce the burden of disease. Ironically, the hospital – the place to which we go for life-saving interventions – is also one of the most dangerous places to spend time as a patient. Deaths related to medical errors have been reported at 98,000 – 400,000 per year, the upper limit of which would make preventable medical errors the third leading cause of death in the US behind heart disease and cancer. (1-2) Despite ongoing and diligent efforts to improve patient safety, receiving medical care at a hospital is still accompanied by substantial risk. Yet, in times of compromised health, the potential benefits of hospital care still greatly outweigh this risk.
While preparing for my career in medicine, I’ve also spent the past five years involved in CrossFit. Although I am aware of frequent discussions in the media of its “dangers,” my decision to participate in CrossFit is no different than any other—I heed my mother’s advice and work to reasonably mitigate the risks and maximize the benefits. The benefits of CrossFit are incontrovertible: increased work capacity across broad time and modal domains, in other words, increased fitness. Whether measuring fitness with a maximal effort treadmill test or the ability to stand from a seated position on the floor, it is well-established that increased fitness reduces one’s risk of death. (3-5) In fact, having a better level of fitness decreases your risk of death more than controlling other risk factors such as your blood pressure, cholesterol, and blood sugar. (6) Quite simply, performing constantly varied, functional movements at high intensity (aka CrossFit) will result in increased fitness, and therefore better your chances of living a longer, healthier, more functional life.
The story of Pete, a middle-aged member of CrossFit Painesville, exemplifies the positive impact CrossFit can have. After a decade of being overweight and requiring an intensive medication regimen to keep his cardiac risk profile “within normal limits,” Pete walked into his local affiliate to give CrossFit a try. Despite challenging workouts and persistent soreness in the initial weeks, he decided to continue with his training. Eventually the soreness subsided and he became stronger, faster, and learned several new skills – his fitness improved. He went on to lose over 30 lbs and cure his diabetes, hypertension, and sleep apnea. Instead of continuing down a road of worsening chronic disease and more medications with their inherent side effects, he chose to endure CrossFit’s discomforts in order to reap the benefits of a fully functional and medication-free life. Pete’s story is not uncommon – nearly every affiliate around the world is likely to share a similar story about at least one of its members.
Yes, the risks of participating in a CrossFit program are also undeniable, ranging from soreness (highly likely), to a temporary musculoskeletal injury (less likely), to a catastrophic injury that permanently reduces physical capacity (very unlikely). Although stories of injuries sustained doing CrossFit run rampant on the internet, these same injuries and much worse are seen in our favorite sports and recreational activities. Personally, I’ve had more severe injuries over my years competing in gymnastics than in CrossFit, but no one ever suggested I should stop doing gymnastics. In honor of the glorious winter we’ve just survived, we can also examine the similar examples of skiing and snowboarding. According to CNN, there are about 2-3 injuries from snow sports per 1000 participants per day.(7) When high-profile skiing accidents bring scrutiny to the danger of winter sports, the International Society for Skiing Safety responds appropriately by advocating professional instruction, taking your time, and using correct equipment as ways to decrease the risk of injury. Under these guidelines, over 100 million individuals still chose to take to the slopes in 2013 alone. In comparison, a study published in the Journal of Strength and Conditioning Research, albeit small and with high potential for bias, reports an injury rate of 3.1 per 1000 hours trained using CrossFit.(8) Similarly, joining an affiliate and working with a qualified trainer, adhering to CrossFit’s mantra of “mechanics, consistency, intensity,” avoiding overtraining, and spending time on recovery (hydration, nutrition, sleep, mobility) are important ways to decrease your risk of an injury while still reaping the benefits of CrossFit training. Just as with snow sports, the risks of participating in a CrossFit program should not dissuade responsible participation.
Every once in a while, risks associated with the things we do become real—they exit the realm of statistics and remind us that we are human, as they did for many CrossFit athletes in the case the spinal cord injury sustained by Kevin Ogar in January. Of note, it is important to distinguish the elevated risk assumed by a high-level competitor over that of a recreational athlete. In pursuit of the benefits of high-level competition, we increase our training hours, perform more advanced maneuvers, and more aggressively push the limits of our bodies. Kevin’s accident forced me to pause and realize the risks I assume by competing in a high-level sport, as I’m sure it did most of my peers around the world. But what I can also state with confidence is that none of us has since thrown in the towel. The rewards we reap in the pursuit of peak fitness are too great to abandon for a small risk of a catastrophic event over which we have very little control. In fact, the rewards of improved functional physical capacity are exactly those which best prepare us to endure and recover from such an injury. Kevin continues to do CrossFit today because he understands its importance to his well-being and his rehabilitation. Similarly, after breaking her neck in a car crash, the strength Miranda Oldroyd had developed through CrossFit likely saved her from being paralyzed and also aided her quick and complete recovery. In these cases, the reasons for training functional movements become more obvious – in order to most successfully navigate life, we must build capacity in the movements life demands of us. When injury befalls us, these movements also provide the best rehab for meeting life’s demands.
Whether you are taking a giant step, racing down black-diamond slopes, or performing constantly varied functional movements at high intensity, life is dangerous. Everything we do has some associated level of risk and benefit. We walk around every day not knowing the exact level of risk and benefit associated with most of our actions, yet it remains our responsibility to decide what’s worth pursuing. I, for one, see an overwhelming benefit to pursuing increased fitness, despite its risks. The soreness, pain, and even emotional ups and downs I experience in this pursuit are worthwhile knowing that I am preparing my body to surmount any physical task, recover from a catastrophic injury, and live a long, functional life with as few visits as possible to the “oh-so-dangerous” hospital.
When my attending stepped out of the room, the patient looked to me and asked, as many do, “How far along are you in medical school?” She was a sharply-dressed woman in her mid-eighties whose cane hardly slowed her down from flying in from Chicago that morning after visiting her grandchildren. Before I could answer her question, however, she remarked, “Oh, you are just so lucky! When I was your age, becoming a doctor wasn’t even a possibility that entered my mind. I was a nurse, but I always thought if I’d had that opportunity I would have made a great doctor.” As she went on to tell me how proud she was of her grandchildren who were pursuing higher education and wish me luck and encouragement in my studies, I was reminded again of how much I take for granted being raised in a world full of opportunity.
As this patient reminded me, women have opportunities today that those only a generation or two before us couldn’t fathom, and we are taking advantage of many of these opportunities. In 2011, for example, 48% of medical school graduates were women; compare this to 30 years ago, when only 27% of graduates in 1983 were women.1 Despite the fact that we are training more female doctors, however, these trends have not translated to healthcare leadership: only 18% of hospital CEOs and 4% of healthcare company CEOs are women.2 Why is this so? While the barriers to career advancement for females in healthcare are many, I’d like to focus on the most commonly cited by the 2011 Rock Health Survey of women in healthcare: self-confidence.2
Facebook COO and Lean In author Sheryl Sandberg speaks to this barrier in her 2010 TED Talk where she focuses on what we can do as individuals to increase the representation of women in leadership positions. Using an anecdote about a class she took in college with her female roommate and her brother, she describes the tendency of males to exude confidence and attribute their successes to themselves, while females tend to attribute their successes to external factors including co-workers and luck.
Hearing this story reminds me of the ways I have come to witness this feature of the female psyche manifest in both myself and fellow female competitors at the CrossFit Games.
CrossFit as a whole has treated male and female athletes with equal respect and opportunity from its inception.3 Workouts of the Day (WODs) posted on CrossFit.com do not include scaling options for females or any other subset of the CrossFit community, suggesting that individuals may chose to scale appropriately but should not feel limited in any way, for example by age or gender. 40% of this year’s CrossFit Games Open participants were women, and on any given day one can expect to drop into a local CrossFit affiliate to find women besting men in workouts involving deadlifts, cleans, pull ups, and the like. CrossFit’s dedication to providing equal opportunities regardless of gender also extends beyond the WOD. Hope for Kenya mobilizes the CrossFit community to raise money to build water cisterns which free Kenyan women from their duties of traveling miles for fresh water each day. In doing so, young girls are provided the opportunity to pursue education and a brighter future. As the Sport of Fitness, the CrossFit Games, has experienced exponential growth over the past several years, it has also continued to provide equal opportunities for competitors of both genders. Prize money, now totaling well over $1 million is distributed equally among male and female competitors, and the number of segments featuring CrossFit Games events on ESPN2 are also gender-equal. Events including 2012’s Pendleton triathlon and 2013’s Pool and Row have also allowed male and female competitors to compete alongside one another, performing the same work.
Despite the abundant opportunities we have as female CrossFit athletes, natural differences between the male and female fields of competitors remain. While it seems that hard work, dedication, and talent should be the only factors distinguishing those who stand on the podium from those who do not, from my own experience and that of my peers, sport is another place where self-confidence can become our greatest barrier to success. Similar to Sheryl Sandberg’s story, a quick sampling of athlete profile videos on the CrossFit Games site will demonstrate that male competitors are more likely to outwardly express their desire and belief in their ability to win. Female competitors, on the other hand, are more likely to state that they “just want to do their best” or are simply happy to have the opportunity to compete. It comes as no surprise that the female athletes who do exude self-confidence and a belief in their ability to win including two-time champion Annie Thorisdottir, 2013 champion Sam Briggs, and 2013 runner-up Lindsey Valenzuela find themselves successful.
So why is it that women frequently lack confidence in their ability to succeed? Perhaps it’s a fear of vulnerability, not wanting to feel disappointed by falling short of a goal. As Sheryl Sandberg suggests, perhaps it’s a fear of not being well-liked, as research shows that successful women are far less likely to be well-liked than their successful male counterparts. Maybe, as Elisabeth Akinwale suggests, it’s a struggle to strike a balance between the virtues of humility and confidence. Self-confidence has been my own downfall as a CrossFit Games competitor in the past, and I can attribute its lacking to each of these reasons to some degree. Examining my career as a medical student thus far, I find similar instances where I wonder whether my own self-confidence has limited my performance. Most recently, for example, I was happy to receive a USMLE Step 1 score that exceeded the goal I had set for myself months ago – but what if I’d had the confidence to set that initial goal higher?
So, knowing all of this, what can we as individual women do about it? We are privileged to live in a generation where opportunity is abundant. There are too many other barriers to success in life to allow a lack of self-confidence to be one of them. This year, I’m vowing to set my sights on the top of the podium at the CrossFit Games. Sure, I might fall short, but if I do, I’ll know that it was because of my physical performance and not because of a lack of belief in myself. So, ladies, whether it’s looking toward the top of the podium, a stellar exam score, a career change, or a job promotion, let’s set our goals high this year and refuse to allow a lack of belief in ourselves to hold us back. Who’s with me?
This post was inspired by XX in Health Week, celebration of female leadership
Whether I was watching 60-year-olds fight their way through events that would leave 20-year-olds gasping for breath, demonstrating events for the competitors alongside legends that inspired me to start my own CrossFit journey four years ago, or offering a quick “Good luck” to someone who had been a rival a year ago, the perspectives offered by my experiences at the 2013 Reebok CrossFit Games are irreplaceable.
I’d be lying to say that I didn’t feel a tinge of sadness over the course of the week or shed a tear or two behind my oversized sunglasses, but between those fleeting moments I was overwhelmed with a feeling of celebration. Along with the impressive contingent of fans, volunteers, vendors, and support staff I celebrated the hard work of the CrossFit Games athletes and their representation of the Sport of Fitness. I sat back and once again reveled in this amazing movement called CrossFit and how it has changed all of our lives.
As I watched Saturday evening’s “2007” event unfold from temporary stands added to the top of the tennis stadium, I was struck by the quality of the view. I’m not sure what I was expecting – I had never actually watched an event from the stands of the StubHub stadium before, but for some reason I imagined that I would feel distant from the competition. However, even from these makeshift seats added due to the overwhelming demand for tickets, I felt close to the stadium floor. I could see the athletes progress through each round of pull-ups on Rogue’s A-frame rig setup. I noticed their technique – beautiful butterfly pull-ups, the visible differences in limb lengths, and some athletes even using regular kips that were faster than the butterflies of their peers. I watched and learned from these athletes who had sacrificed all year for this moment.
Perhaps it was because I had been there myself just a year ago, or perhaps my seat really wasn’t all that far away, but I like to think that watching the CrossFit Games offers a perspective unlike any other sporting event. Whether you are an athlete, fan, or volunteer, CrossFit has changed your life, or at least the life of someone close to you. As I encountered individuals in various volunteer, staff, and vendor roles throughout the week, I observed a common thread – although all were working incredibly hard and I could see hints of stress and fatigue on their faces, their happiness and passion for making the event a success was overwhelming. It was clear that there was no place in the world that these people would rather be than at the CrossFit Games, working hard as they do every day in their own boxes around the world. Each of these individuals plays an integral role in making the CrossFit Games a true celebration – not only of the athletes in the stadium, but of those filling the stands, changing the equipment, and taking the photos and videos. After all, it’s these athletes and this community that supports and inspires the athletes on the floor to expand the boundaries of human potential each year.
Sitting among family, friends, and fellow athletes as I viewed the CrossFit Games from many different perspectives this year, I realized that although the perspective of competitor is most reveled, when you’re with this community, there is truly not a bad seat in the house.
Perspective is both necessary and sufficient ground for wisdom. – Jonathan Lockwood Huie
We talk all the time about how our experiences inside the four walls of the CrossFit box translate to life outside, but never has this truth been so glaringly apparent to me as in my preparation for the USMLE Step 1 board exam. As the hours, days, and weeks of flashcards, Qbanks, and practice exams dragged on, I couldn’t help but notice the ways in which my CrossFit training had prepared me for this intellectual challenge. Reflecting on this experience, I’ve collected the top 12 reasons why CrossFit prepared me for the task of studying for and taking the USMLE Step 1 exam:
A little over a week ago, I attended the third annual Cleveland Clinic Lerner College of Medicine (CCLCM) Research Day. This afternoon serves to highlight and celebrate the research of our recently-matched and ready-to-graduate fifth-year students and also brings together nearly all 160 CCLCM students and numerous faculty for a lecture in memory of Iva Dostanic MD, PhD, CCLCM Class of 2011. This year’s lecture strayed from a traditional research presentation in order to feature scenes from the 1999 Pulitzer-prize winning drama Wit, interspersed with narrations by its author Margaret Edson. For a little over an hour I watched the unraveling of the play’s lead character Vivian Bearing, a renowned English professor being treated in a research hospital for stage four ovarian cancer. As we witnessed the juxtaposition of characters clinging to their professional identities of professors, physicians, and scientists with the slowly increasing exposure of Professor Bearing’s vulnerability, Margaret explained her motivations for crafting the play in such a manner. She explained how she envisions every person to have three different “selves.” First, we have a busy self – this is the self that most people identify with for the majority of their lives. This busy self is the self that is doing, accomplishing, earning, pleasing – creating and maintaining an identity recognized by the outside world. Margaret refers to our physical self as our slimy self – most of the time this self operates on its own, and in the case of a malfunction doctors and scientists are tasked with its repair. Margaret finally describes the true self, the self that remains when one day both the busy self and the slimy self have gone. She describes that for most individuals, the busy self predominates; however, in brief moments we are afforded a glimpse of our true selves. In Wit, Margaret strips Professor Bearing of both her busy self and slimy self – confined to a hospital bed with scientists bustling about her as if her body is nothing more than a research specimen, Professor Bearing fights to cling to her busy self identity until at last, in the final scenes before her death, she relents and allows the exposure of her true self. In her narration, Margaret describes the necessity of this terrible struggle in order for Professor Bearing to experience her true self, if even for only a few moments before her death. Painful as it was to watch Professor Bearing’s suffering in these final moments, Margaret argues that it would have been far more tragic had she died according to her own heroic dream- reaching for a book on the top shelf at the library – having never been challenged to discover and embrace her true self.
As I reflect on this performance and some recent discussions I’ve had, I realize how closely this dramatization resembles the experience of most individuals in our culture. We proceed through life so preoccupied with our busy selves that it often requires a wake up call in the form of a threat to our busy selves (losing a job or particular role we play) or our slimy selves (an illness) for us to stop and spend a few moments connecting with our true selves. Even in this situation, we often we grasp for our busy or slimy self identities to prevent the exposure of our true selves. I can’t imagine how frightening such a dramatically life-changing event must be on its own, but facing this event while simultaneously meeting one’s true self for the first time would likely prove much more disorienting and overwhelming, in my mind.
So, how can we try to touch base with our true selves prior to such an event so that we may be better prepared to handle the threats to our busy or slimy selves that will undoubtedly ensue? One approach lies in distracting our other selves such that we permit our true selves to shine through, and I’d like to propose the argument that walking into a CrossFit affiliate allows us to do just that. One of the many reasons I love walking into a CrossFit affiliate is that entering inside those four walls forces us to abandon our busy selves. Inside a CrossFit affiliate, no one knows or cares whether you are a world-renowned physician, researcher, English professor, mother, musician etc – all that matters is that you are there, ready to work hard to move better, improve your fitness, and support those around you to do the same. While normally we cling to our busy identities, a CrossFit affiliate provides a safe space for us all to let go and take on the identity of an athlete. While it may be true that CrossFit forces us to focus on our slimy (or physical) selves through exercise, I’d like to propose that by taking our bodies to the limits of their capabilities as we do in CrossFit, we lose the ability to maintain complete control over our slimy selves, and this effort transcends the physical to the mental and emotional. Any CrossFitter can identify with a moment when your body has failed, forcing you to stand gasping for breath over your barbell near the end of a workout. You have 5 reps left, and you’re starting to question whether you will finish. You can hear the words of encouragement from your trainer and peers somewhere off in the distance, and in that moment you make the decision to step back to your barbell and keep forging ahead. It is in these moments, which happen every single day in CrossFit affiliates around the world, that individuals are stripped of their so-called busy and slimy selves and stand face-to-face with their true selves.
It is in a brief moment in Wit when Professor Bearing connects with her research resident that ultimately allows her to begin to expose her true self. In her narration, Margaret emphasizes the importance of human connection in discovering our true selves in the midst of the chaos of our lives, a theme we are again no stranger to in the CrossFit community. Not only does CrossFit strip us of our busy and slimy selves, but it allows us to do so in the presence of others, facilitating the connection with our fellow human beings and thus allowing us to make sense of our crazy, chaotic lives.
By providing this opportunity, CrossFit regularly forces us to ask our true selves questions such as “Who am I?”, “What am I made of?”, and “How am I going to approach the challenges that life brings?” As we gain this insight, we are better equipped to embrace our true selves and more fully understand the meaning and purpose of our lives. When faced with a threat to our busy or slimy selves in the future, such an understanding of our true selves will better prepare us to face these challenges with resilience and grace.
Thank you to Laureen Nemeth for the photos used in this post.
“How do you balance medical school and CrossFit?” This is the one question to which it seems everyone wants to know the answer. I usually just smile or laugh and remark with a similar expression of perplexity, “I don’t know either – I’m still trying to figure it out!” I could talk about time management tips and strategies for maximizing efficiency, but those who are close to me know that I am far from mastering any of these skills. The truth of the matter is that in my experience, more importantly than time management, achieving balance begins with defining reasonable goals.
Last year, I entered medical school at the Cleveland Clinic Lerner College of Medicine with a goal of also competing in the 2012 CrossFit Games. With a good understanding of the first-year curriculum, I knew that it would be possible to dedicate the necessary time to training while still fulfilling my medical school requirements. Knowing that the path toward these two tasks I was simultaneously attempting to surmount would be physically, mentally, and emotionally draining, it was also important for me to spend time reflecting on why I wanted to pursue each one. As the year progressed, this reflection would prove invaluable as I reminded myself of these reasons with each moment of doubt, frustration, or exhaustion along the way, empowering me to steadily press forward. The incredible support of family and close friends in and out of the gym also kept me focused and reminded me of what is truly most important in life.
Based purely on my own limited experience, here is my best advice for achieving balance:
*Note: This in itself is a lofty goal and one that I struggle most with!
Now comes the hard part: it is time to take my own advice. As I look toward the upcoming year, I again must define my goals and ask myself why I am choosing to pursue each one. This second year of medical school is a critical one in my program, with increased classroom commitments and a significant demand to prepare for the first medical board exam in June. As I pursue my goal of becoming the best physician I can be, this year stands out as one that will lay the groundwork for caring for patients in the future. Recognizing the importance of this goal and the time commitment necessary to pursue it, I know that this year it must be prioritized above others, including competing in the 2013 CrossFit Games. As much as it pains me to consider not competing in the sport I love, that has become a part of who I am and who I aspire to become, I know that in this particular year, I have another goal that has to take precedence. I have considered every possibility (believe me, every possibility), and I have decided that rather than giving half an effort to medical school and half an effort to the CrossFit Games this year, I must shift my focus to dedicating a full effort to school and the board exam.
It is important to set our goals high and to push ourselves beyond what we think we are capable of so that we may ultimately reach our full potential. I believe it is also important to remember that we are human – and that some goals are just too important to sacrifice. I would never want to look back on this year and my career and wonder whether I could have done better had I not been distracted by training for the CrossFit Games. This year my goal is to crush the USMLE Step 1 exam, and in order to reach my full potential in this endeavor I know it requires me to sacrifice training for the 2013 CrossFit Games. But don’t you worry – I’ve still got my eye on the top of the podium in 2014, and training for that particular goal starts today. 😉
Well, this post is certainly long overdue – the whirlwind of starting back at school has kept me busy these past 2 weeks! Much more reflection on my experience training for and competing at the 2012 Reebok CrossFit Games is to come, but I must start by expressing my gratitude for all of the people who have supported and enabled me to follow my dream this year. What you don’t see during that single week in July are all of the moments during the other 51 weeks of the year that make that performance possible. This year, more than ever, I have learned that although it is important to be strong and determined oneself, it is equally important to know when to lean on others. I have been fortunate enough to have leaned on more than a few people this year, and I cannot even begin to describe how thankful I am for their support:
My training partner – without her sweating by my side, every single day, I simply don’t know how I could have kept going!
My family – for always encouraging me to do what I love, and loving me no matter what I do
My amazing boyfriend – I think he deserved to be standing up on that podium more than me for what I put him through this year!
My coach, Doug Chapman – who is much more than a coach, and who brought me from here to the podium in three years. Embarrassing as it is for me, I think this video illustrates that he had his work cut out for him 😉
My HyperFit USA family – for everything over the past 3 years, you guys really are like family
My new CrossFit pals in Cleveland – thank you for welcoming me into your community and for your support and friendship
My school – thank you to faculty, friends, and fellow students who have supported me and allowed me to chase my dream this year
Reebok – for continually striving for improvement while staying true to what CrossFit is all about
Every staff member, volunteer, judge, etc who made the Games possible – Thank you for your passion and dedication to what you do, and for allowing us athletes to have the time of our lives out there
The CrossFit community – for your enthusiasm and energy. To every single person who sent me a message or cheered me on- your support means the world to me!
And to the man who started it all, thank you for changing all of our lives forever and for enabling us to make the world a better place each and every day!
As I look toward this weekend, my excitement is building for CrossFit for Hope. In my first post I wrote about the connections we make through CrossFit that allow us to elevate not only each other but the community as a whole. With so much attention focused on the CrossFit Games this time of year, CrossFit for Hope provides a timely reminder of what the Sport of Fitness is really all about- – coming together to make one another and the world around us better.
We have a truly amazing and unique community that continues to grow by the day. There were 0ver 60,000 participants in the Open this year – pretty remarkable! Now it is time to harness the power of this community to support a great cause. The beneficiary of CrossFit for Hope, St. Jude Children’s Research Hospital, epitomizes what I aspire to be a part of as a developing physician researcher – providing the very best patient care and constantly striving to expand the boundaries of medicine. We have a chance this weekend to support St. Jude’s mission of finding cures to cancer and childhood diseases through treatment and research. Just think – if every participant in the Open were able to raise just $30, we would surpass our goal of $1.7M.
This is what it’s all about, people. Sign up, do the workout, at the very least make whatever donation you are able to your box or someone you know. I look forward to fighting through the Hope workout and supporting this cause on Saturday with all of you!
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.
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.
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.
We’ve spent the last two weeks of medical school in our Endocrinology Block. Returning from a much-needed and very restful break for the holidays, I was excited to be learning about a new system and expected the coming days to be filled with discussion of those elusive glands and hormones I’d heard of, but never really knew exactly what purpose they served. While we did spend plenty of time learning about things like T3 and T4, Chromaffin cells, and the difference between the anterior and posterior pituitary, to my surprise (and perhaps also to my fascination) a significant portion of the past two weeks revolved around obesity.
We have learned about the genetics of obesity, how hormones and neural networks control how much you eat and how much energy you expend, and all the hormonal factors that our fat cells release contributing to insulin resistance. We talked about a number of endocrine diseases that lead to uncontrollable weight gain or loss, but what resonated with me most was this figure that seemed to kick-off every other seminar I participated in, highlighting America’s “Obesity Epidemic:”
With all this buzz about obesity, I was fascinated by how quickly the word “exercise” passed in and out of conversation – as if it were some sort of fictional idea, a figment of the imagination that only worked in fairy tales and highly-controlled research studies. Instead, after rapidly dissuading the eager medical students’ suggestions of “lifestyle changes,” clinicians quickly turned the focus toward pharmacology and novel molecular targets for treating this epidemic. Did I miss something here? At first I was quite perplexed – if we know that exercise affords us countless health benefits and is likely to prevent diseases from diabetes to cancer, why are we searching so hard for the “magic bullet” drug to treat obesity and leaving this thoroughly tested and proven antidote to the wayside?
What strikes me the most about many of our seminar discussions with highly-esteemed clinicians is their sheer lack of faith in the ability of any patient to adhere to an exercise regimen. But then I stop to think – can I blame them? Though I’ve only been immersed in the field of medicine for half a year now, I’ve become accustomed to the standard “diet and exercise” talk. Patients in need of serious lifestyle change are sent off for an appointment with the nutritionist and told to “exercise.” Now talk about an elusive idea – if I had been living an increasingly sedentary lifestyle for much of my adult life and was given these instructions, I would have no idea what to do either. Heck, I had no idea what to do or how to exercise the minute I was set free from my high school sports programs, and exercise had been part of my everyday life for years! The plethora of weight loss and fitness advice we are constantly bombarded with doesn’t help one bit – with so many options, many of them contradictory, and different people asking for your money, it’s nearly impossible not to become overwhelmed and discouraged before finding a program that works. So, why is it that doctors frequently leave it up to their patients to figure out? Sure, they might suggest Weight Watchers or purchasing a gym membership, but ultimately this choice is left up to the patient. Do we leave other choices of this magnitude up to our patients? If I came in to see my physician with strep throat, would he make a few suggestions of what medication I should take and the dosage and leave it up to me to decide? Absolutely not! If I needed to rehabilitate a torn ACL would my doctor point me to a few online resources and send me on my way? Not at all! Next thing I know I would be standing in a physical therapy clinic receiving step-by-step instructions from a doctor who had helped countless others through ACL rehab, and I would be returning several times a week to ensure my therapy was completed fully and properly. So why is it that exercise, perhaps the most important and life-saving treatment of all, is so improperly “prescribed” by our physicians? The problems are many-fold, and as far as I can see they stem not from the doctors themselves but rather the health care system in which these doctors work. However, at least in my mind, the complexity of these problems doesn’t preclude working toward a solution.
After these past two weeks, the disconnect between medicine and fitness has never been so apparent to me. While I always knew it existed, there is just quite nothing like experiencing first-hand the Grand-Canyon-sized gaping hole between experts in sickness and wellness, and experts in fitness. My favorite of CrossFit’s models of fitness is by far the “Sickness-Wellness-Fitness” continuum, yet in the context of medical care, this continuum is not quite as smooth as we might hope. Instead of individuals oscillating freely along from wellness to fitness, fitness to wellness, and occasionally (God forbid) inching over to sickness, we have a serious traffic jam on the Sickness-Wellness side of the spectrum. People are stockpiled on the cliff we call “Wellness,” peering over the edge and looking down at the polluted waters of “Fitness.” That’s a scary jump to take – and who knows where you will end up once you do? A $10-per-month gym membership? $100 for a video that promises to give you a six pack? What we need is something to bridge this gap – someone who can take patients by the hand and lead them toward the right side of this continuum, and it’s clear to me that CrossFit may just help us find that someone we need.
“Your doctor is a lifeguard, not a swim coach” – Coach Greg Glassman.