Collaboration Versus Competition

The other day my wife and I were attending a parent information night at our daughters’ school. Our girls attend a small private school that utilizes a well-known alternative teaching method. During the course of the presentation, the teacher spent some time outlining the guiding principles of this alternative method. On this list of teaching philosophies was a bullet point that caught my attention. It read “collaboration versus competition.”

As a medical educator, this struck me. I’ve been reading a lot lately about what is wrong with medical education these days. It seems there are many who  feel there needs to be more emphasis placed upon “soft skills” rather than hard science. It is felt that enhancing these skills trains better physicians with greater ability to relate to patients.

I cannot say that I completely disagree with this idea. Having come up through a traditional medical school model and post-graduate medical training, I can see in my own self the changes that occurred  which can more or less be attributed to the system. This system breeds an ultra-competitive environment. As college undergrads we compete fiercely for GPA and MCAT scores to gain entrance to medical school. While in medical school we compete with our classmates to gain acceptance to coveted residency programs. While in residency, we work hard to distinguish ourselves among the group so that we can gain access to highly sought after fellowship training programs or practice opportunities.

It would be nice to say that the competition is limited to the educational and postgraduate training years but unfortunately it is not. Practicing physicians having gone through years of competition cannot shed this attribute easily. They often go into practice and continue to compete only this time for development of patient panels, income/compensation and now the increasingly important patient satisfaction scores.

Now more so than ever the practice of medicine has truly evolved into a team sport. Delivery of care that is compassionate, high quality and cost efficient will require adherence to the other “C – words.” These are communication, connectivity and collaboration. In order for the healthcare team to function effectively, the individual needs to be de-emphasized and the collective team approach should be championed. The good of the patient needs to be put in front of everything and failure to meet the needs of the patient should constitute a failure of the entire healthcare team.

I am fortunate in that I have the ability to participate in the development of a brand-new medical school campus. As a medical educator this is perhaps the most exciting prospect of my career. I see this as an opportunity to help create a new environment that rewards collaboration over competition. This would only make sense as this medical school is being born out of the collaboration between a major University and a private hospital. Furthermore, this new medical school, much like my daughter’s elementary school, will be an alternative educational venue. The school will be developed to marry the disciplines of medicine and engineering. The concept of collaboration is at the very crux of the development of this new institution. I can only hope that this spirit carries forward into the teaching methodologies of its future students.

I’ve been in practice for nearly 13 years. During this time I’ve seen rapid changes occur in the practice of medicine. It is essential that medical schools and postgraduate training programs adapt quickly to these changes. It is important that we are equipping the young men and women who carry our profession forward with the right tools to succeed.

I am not naïve enough to think that we can completely eliminate the competitive nature of medical education. There will always be some element of it being a “numbers game.” However, I don’t believe that there is a medical educator out there who can refute the idea that we all can do a better job of preparing our students to function as effective members of the healthcare team. This means more emphasis on developing communication and interpersonal skills. Perhaps medical students need to participate in more group project type activities like business school students. However,  it is incumbent upon us as the educators to lead by example. We ourselves need to change. We as educators and practicing physicians need to model the type of behavior that we expect in our students.

In closing, think about this. Many times when the healthcare system fails a patient, it is not based upon a cognitive or technical error. Often times is the result of a poorly functioning team and lack of effective communication. We’ve done a reasonable job over the years in teaching our students the hard skills needed to become physicians. However, we now need to expand this, to foster an environment of cooperation and collaboration. This will ensure that our students will thrive in the profession throughout the years to come.

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