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Gunners Blazing

Hypercompetitive colleagues can threaten the team. But where would we be without them?

The New Physician May-June 2010

Cover story artThey are the infamous hard chargers. They aim for the top residencies. They alienate others. They spend all their time studying. They aren’t interested in teamwork. They sit in the front rows of classes and answer every question. They are seemingly malicious and upset the classroom environment.

A gunner is a classmate who aggressively strives for his own success, occasionally at others’ expense. It’s the gunner’s hand that shoots up time and time again to answer an instructor’s question first, crowding out colleagues.

There are good points to being a medical school gunner, like discipline and sacrifice. But there are Web sites making fun of them—even medical students posting a song lampooning gunners on YouTube. And the negative is that ultra-competitiveness has nothing to do with patient-centered medicine.

The subject brings up strong emotions. The definition of “gunner” can vary, and being considered one can be offensive to those who simply consider themselves high achievers. The good part of having gunners in your class is that in the right circumstances, they can motivate colleagues to do better. But for the most part, gunners are not only a detriment to their own interpersonal classroom relationships, they are bad for the learning environment as well.

Ultimately, the problem is egocentrism, and disregard for fitting in with classmates and the doctor’s humanistic mission, say faculty members.

During her first year, the gunner mentality initially rubbed off on Rachael VanDeBogart, now a second-year at the University of Nevada School of Medicine. But now, asked if she is a gunner, she’s adamant: “Absolutely not,” she says. “Absolutely not.”

While VanDeBogart intends to become the best doctor she can be, her goal is not fantastic grades. It is treating her future patients well. She is happy with average grades if it means a balanced life and a diverse background with which she can best relate to them, she says. Before medical school, she had different life experiences than her colleagues, working as a waitress, restaurant manager and other jobs, all of which let her see the “real world.”

The gunner’s off-putting manner, while likely unintentional, can wreck the harmony in a class.

“I think it would be very easy to make some enemies in medical school,” she says. “I think it would be very easy to say the wrong things. There are about 55 in my class and it’s really small. If you make problems, everybody is going to know about it, and we have to get along. And we have to maintain professionalism in our interactions with peers.”

Casey Grover, a fourth-year at the David Geffen School of Medicine at the University of California, Los Angeles, has been considered a gunner, but not in the stereotypical, negative sense. He says he wants to provide the best care to his future emergency medicine patients. “There are two types of gunners, and I am of the second type. The first one is cutthroat and wants to do better than everybody else, and there is an adversarial role. And the second type are those who work really hard and are concerned about what they’re doing,” says Grover, who is president of UCLA’s chapter of Alpha Omega Alpha, the competitive medical honors society.

“I tend to be very vocal when working in small groups, and I try to get a lot out of what we’re doing,” he says. “I think it is how well people know me. And if they don’t know me, they could be intimidated. But after a few minutes, they would find out there is nothing mean or malignant about what I do. I just want to get a lot out of medical school and my rotations.”

Cutthroat gunners are few at Geffen, he says, partly because the school does not have traditional grades.

Classmates have mentioned his intense manner, but Grover says he just wants to help. “For those who study and know the answer, it is really hard not to answer that question when a classmate is struggling.”

Jokingly, he says he tries not to overshadow classmates and “keep [his] mouth shut and give [them] a fair chance.” At a light-hearted UCLA banquet, he was awarded “biggest gunner.”

Not all high achievers are stereotypical gunners, but it affects others, say medical students and instructors. Underlying the insecurities, stress, and being unable to relate to others is a lack of understanding of the importance of teamwork and caring for patients, not about themselves and their grades.

Some students and faculty value knowledge more than anything else. When one professor was evaluating students and looking at who had done community service, he asked why that shouldn’t count against them. “We thought he was kidding, but he wasn’t. He thought they should have spent more time in the library,” Grover says, adding, “I think most of the schools now encourage good patient interaction.”

Dr. Tarayn Fairlie wrote about gunners in a school publication as a first-year at Harvard Medical School. Now a resident in pediatrics, she has seen gunners in practice. An Oklahoma native, and the first one in her family to attend college, she was able to succeed with a balanced life despite high expectations. In her article, she gave tips to avoid being a gunner, such as having outside interests and avoiding isolation.

In medicine, being a gunner is not appropriate, she says. “I think when they finally head into their second year, they realize that there could be other things that they could be doing, such as clinical work.”

And gunners cause problems with patients and co-workers. It can be difficult for those with social stresses to deal with a battered patient coming into the ER with trauma, for example.

“In residency, you learn what not to do with patients, and [successful residents] are certainly not gunners. If they were, they would get fired, and they wouldn’t be able to take the shame in general. And they are toxic to their colleagues. They are terrible to work with.”

In the end, it is not about competing with others. “You have to run your own race,” Fairlie says. The gunner lifestyle is unhealthy for them, she says. “There are people who are committing suicide because they spend all their time studying.”

Jonathan Wisco, an assistant professor of gross anatomy and a former Harvard fellow, has taught at various levels including high school. Like Fairlie, Wisco is also concerned about the well-being of overly competitive medical students themselves. “There is a very small set of gunners who tend not to have good coping skills. For them, in academic life, it’s fairly easy,” he says. “They know how to motivate themselves to be excellent, but they eventually hit a wall because they never had to deal with adversity. And then they don’t know what to do.”

Much has changed in medical education in the past decade, he says. Now, competitive residencies require more than good grades. Soft skills are needed as well. Group work and humanism are key. And if one person fails in the group, they all do.

In a recent doctor visit, Wisco could tell what demeanor the physician had as a medical student. “He was a gunner, but he had the bedside manner of a rock. He would never have made it with today’s changes.”

“Twenty years ago, it was about who you needed to step on to become a surgeon, but now on clerkships you have to work on teams to become successful, [and] one person can determine whether the whole team is successful,” Wisco says. “And it forces students to be successful based on other people’s efforts.”

“I realized, when I was an undergraduate and applying to schools, if you do the hard work, the grades will follow,” he says. “And gunners can really get wrapped up in grades and lose the point. What’s hard about taming a gunner is realizing that their life is not the next exam…it is about patient care in the long haul,” he says.

Wisco says they can be off-putting to faculty as well. “I had a student who came up to me and literally demand that I give her information without going through the process. And I have a strict policy. I say no,” he explains.

“Even though gunners can be annoying, there is a positive aspect of gunners, and they can potentially bring up the rest of the class to do better themselves. And that is the positive aspect of having gunners around to motivate others,” Wisco says, adding that there is a fine balance for students and professionals to push themselves and not to tip too far.

“The qualities of the gunner, used in the right context, are very positive,” he says. “They are motivated. They are the ones who make medical discoveries and perform on a high level, or they can use it in a selfish sense. It’s a fine balance, and choosing to be more altruistic comes with maturity. But if there are a lot of them, they tend to pull the rest of the class down.”

When gunners move up from undergraduate work to medical school, they are very egocentric, Grover says. “However, when that melts away, what is left is a drive that I think is a very positive result of the process.”

Wisco is not advocating slacking off, either. “It is just as bad to be too passive,” he says. It is best to come to a healthy center. “Mediocrity is not the aim. We want all physicians to be excellent,” he adds.

And watching gunners change over time is satisfying, Wisco says. “What is enjoyable as an instructor is to see them mature and bring other people up.”

VanDeBogart was negatively influenced by gunners in her first year. “If I think the major focus is to look at other people’s grades, that adds another layer of misery,” she says.

“The first year, I spent a lot of time comparing myself to my classmates, and it was about beating out the other guy. And it was driving me insane,” she says.

VanDeBogart is originally from Reno, where her school is, and it’s important to her to spend time with family, not just study.

“I am not cramming, and I maintain relationships outside of medical school and stay sane. And I get the material,” she explains.

“If we spend most of our time in a book, we become more robotic. And the people we treat are not going to medical school,” she says. “They are going to be regular people, and I think I’m going to be healthier and better able to communicate with my fellow patients.”

She doesn’t think the difference between an A or B is paramount. “It’s not everything,” she says. “There are certain people who need the recognition, and it is a piece of paper. I don’t know if that makes them better doctors.”

“How is it going to apply to my real life to make sure I know every single enzyme?” She is excited about her third year and starting to work with patients.

“My career is going to be fine either way.” Her aim is internal medicine or emergency medicine.

“I had really good MCAT scores and [admissions] looked at my whole person, and I got into medical school. And I think that same thing is going to happen for residency. And I don’t want to end up in a residency where they are only going to look at my numbers.”

Steve Woo is associate editor of The New Physician.
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