A professional’s career journey depends largely on how well-equipped she or he is. Consider the following parallels:
Muscles Medical education is like an indoor gym where work on basic science and clinical muscle groups proceeds with personal trainers under relatively controlled conditions. Most students eagerly anticipate the more open air of residency, but they don’t truly experience the “big sky” until their first job. They then discover many necessary but undeveloped muscles, such as personnel management skills and capacities such as maintaining optimism in the face of failure.
Cardiovascular fitness A physician’s professionalism and commitment to excellence are like cardiopulmonary power. Though all hikes require a basic level of fitness, some paths, especially service to underserved populations and leadership roles, demand a great deal of fortitude and courage (“heart”).
Compass Once a person develops guiding insights into their birthright gifts and enduring interests, these strengths and values function like a compass. Especially in poor conditions, it’s easy to lose sight of why one became a physician; remaining connected to this source of meaning is essential to staying on the chosen path.
Self-efficacy is the conviction that one can competently set goals and achieve them.4
Like well-fitting boots, accurate self-confidence provides the traveler a definite advantage. However, the results will be suboptimal if one’s self-concept is either too big (i.e., arrogance) or constricting (i.e., self-limiting).
Binoculars Hikers need binoculars to gain data about what’s ahead and for pulling in views. Similarly, professionals need to sharpen their analytic focus on critical features of the organizational culture (e.g., what skills are most valued) as well as on distant horizons (e.g., funding trends).
Walking stick Supports such as family and friends are essential to maintaining equanimity, especially when crossing a swift stream (e.g., transitioning into a new role), ascending a steep cliff (e.g., adjusting to new demands), or traversing rocky terrain (e.g., competing for a job). Supports are not standard issue; hikers must discover and take care of what they need.
Maps Smart travelers seek accurate representations of the terrain. For career development purposes, promotion criteria and the organizational chart provide a basic orientation to the Academic Health Center’s (AHC) most obvious features and opportunities (though hard to interpret without the help of a guide). Career and faculty development literature and courses also offer partial maps. But critical information is always missing (e.g., how to become vice-chair, how the promotion committee determines national reputation). And trail conditions change with little warning (e.g., the chair departs, a program is closed).
Trail guides All hikers, especially the inexperienced, benefit from the individualized counsel of guides familiar with the terrain. Renowned trailblazers are in high demand and are also busy maintaining their own fitness, so establishing a relationship with such an expert can be difficult. Another challenge for guide-seekers is that some experts are so specialized they know only their own trail; others are working from out-of-date maps. Being an expert is no guarantee of listening or communication skills; some experts simply convey their version of “the path.”
As well as consulting more than one guide, savvy hikers therefore seek advisors with relationship skills and up-to-date information. They also stay in contact with hikers immediately ahead on the trail. Given breakneck performance pressures, however, some travelers may not pause long enough to share what they know; those who are racing each other are even less likely to cooperate.
Pack Physicians wear their responsibilities like a backpack. Particularly dangerous for physicians is both over-identifying with responsibilities such that the pack becomes welded to their identity and carrying chronically overloaded packs. Periodically taking the pack off and reassessing what one is carrying are necessary for resilience.