Philosophical Advice for a Pre-Med Student with Grade Struggles

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M writes,

Dr. Fincke,

I read your article online about overcoming intellectual insecurities and it really hit the nail on the head for me, more than anything I’ve read or heard in my life concerning the topic.  I’m going though a major point in my life with regards to my future, specifically my career.  Basically, the next 6 months will determine the path of the rest of my life.  I apologize in advance for the long email, but I really think you need to hear the full story to understand.

Just to give you a bit of background, I have wanted to be a doctor for as long as I can remember.  It sounds so cliche, I know.  But the only career I ever considered otherwise was teaching, which didn’t quite excite me as much.  I’ve always been considered “the smart child”.  Gifted.  Always highly respected by my parents and other adults. Given opportunities that other students weren’t offered.  I was accepted into one of the best high schools in California, which I started immediately after elementary school.  (7th-12th) I did plenty of extra curricular activities.  I was taking SAT courses every summer to reach a score over 2000.  I went to a prestigious university where I took all of my prereq science courses and simultaneously was involved in a number of leadership roles, jobs, research positions etc that could easily fill a 3 page resume in size 10 font.  I’m not gloating, but rather I’m highlighting the tenacity with which I’ve chased after this dream, and for how long I’ve been doing it.  All the while, I’ve been torn down by the authority figures I looked up to the most (favorite science teachers, principal, counselor), who openly expressed their doubts in my ability to succeed and strongly advised me to look into less prestigious schools and maybe even HBCUs.  Peers who knew nothing about me made clear how much they didn’t think I was capable of.  I won’t say it was always because of the color of my skin, but other students who weren’t African American didn’t seem to have this problem. Since then, I’ve had many issues with my race that have distracted me in more ways than I can count.  I could discuss my identity issues for days, but I digress.
My father was a civil servant for 30 years, and my mother an accountant.  Both of them came from very humble beginnings and overcame levels of adversity I couldn’t begin to describe or imagine going through.  They instilled in me a level of motivation and belief in the ability to get through any difficult time, no matter how hard things may seem, and accomplish anything I put my mind to.  I’ve always seen myself with this identity of being intelligent, and knowing I’m going to be a doctor one day.  I’ve always admired myself for what I wanted to do with my life and the lives I wanted to be able to change for the better.  I’ve always had a passion for this path and have dreamt about the things I’d like to be able to accomplish as an MD.  I didn’t get involved with social activities that might take away from what I wanted to accomplish in life.  I feel as though I sacrificed much of my youth to be able to reach my goals, to the point that I’m not even a person I truly am happy with.  I haven’t gone through stages of development that I feel most people already went through in high school and college.  I’m far from reaching a level of confidence I feel I should have reached 5-7 years ago.  All because I was so focused on a goal that I don’t even think I’ll be able to reach anymore.

I’m 24 years old, and in grad school.  I’ve been accepted into medical school contingent upon the completion of this degree with at least a 3.2 GPA.  It really was the perfect set up, as I definitely wasn’t prepared for the rigors of medical school before I started.  I have been growing and learning about myself.  I’m fully independent, living across the country, and trying to become the person I’ve always wanted to be.  However, this program has highlighted the depths of my personal insecurities- intellectual, self-image, life readiness, etc.  Since I started, I’ve been gradually doing worse with each exam.  My best semester was the one in which I tried the least, and finally let loose a little and partied.  The more effort I put into my classes, the more anxiety I feel, and the worse I do.  I have one more semester left of this program, but in order to move on next year, I have to get a 4.0.  I don’t even have room to get an A-.  I only have 2 classes to take, and I have a bit of background in one, so I’m only very minutely optimistic.  I’m afraid the anxiety I know will start to build up with the beginning of this next semester will be my biggest setback and might cause me to fail. I’m positive this was my issue last semester.  But now the pressure is even higher than before.
Last semester was the first time in my life I decided to stop letting my intellectual insecurities hold me back from trying to fully understand the material.  Deep down, I can admit that I never put 100% into my classes for fear of failing after all of that effort.  However, this semester, I did worse than I’ve ever done.  I’m doubting myself now more than ever, and now I feel as though I’ve worked my entire life for something I truly wasn’t capable of.  All the people that tore down my self esteem calling themselves telling me the honest truth may have been right the whole time.
The reason I feel that you may be the person to talk to is because I realize that I understand things differently than most people do – in almost every area of life.  The way I take in information and process it is deeper for me.  I tend to have deep conversations, see a deeper meaning behind things, think about topics to their very core, etc.  I’ve always been told, “It’s just not that deep.  It’s not that serious.”  I realize that people who do well in medicine are so far from this type of thinking.  They’re actually the most superficial people I know.  They don’t process medicine the same way I do.  Things take more time for me because of the way I come to understand them and strive to know topics on a deeper level.  The professor never explains things that way.  The book is always too simple for the way I need to understand things to be able to answer complicated questions.  Sometimes my thinking goes tangential and not the path necessary to come to the conclusion the professor is looking for.  But simply remembering facts is not the way either.  I have a horrible memory, and I’m starting to realize its because of how much I think about on a daily basis.  There’s no way I can retain hundreds of facts and also think about the lists of topics that pop up in my mind every day.  Repetition is key for me, I know.  But how practical is that for even next year when the work load is doubled, and the amount of time I have to know it and remember it well is halved?  I just want to be successful.  And for once, I’d like to see the fruits of my labor.  I sometimes feel that my inability to be successful academically, is the reason for my obvious lack in confidence.  I just don’t know how to improve, since I seem to be the only person who thinks this way.  Maybe I’m missing something.  Maybe I have some anxiety disorder or other pathological issue.
Anyway, If you did finally make it to the end of this email, I appreciate your time.  Not sure if you’d be able to relate or even understand.  But I figured it was worth a try.  I just want to be happy.  And I’ve only ever prayed that I was pursuing the career God meant for me.  To start over at this point is really almost too much to bear.  I’m really not looking forward to a life at the end of this semester that doesn’t start with a white coat ceremony.  I’d be devastated.  Maybe if I can figure out a way to process information differently, that would change things for me.
Thanks for your time,
M.
The most important thing for you to burn into your mind as a bedrock truth is one very simple fact: no one, no matter how smart or talented, is exceptional at everything. Our innate talents and dispositions vary, and since time, resources, and opportunities are limited each one of us inevitably is going to have to make choices about which abilities to prioritize cultivating and which ones we will either accept mediocrity with respect to or even sacrifice altogether. And so it is absolutely imperative that you not self-sabotage your life by deciding that your intelligence, your talent, or your worth hinge on whether you have any one specific ability or career that in the abstract you expect yourself to have. Whether you get into medical school is not a test of your intelligence or abilities in general. If it turns out the door to medical school gets slammed on you, the next question is only one of where to apply your intelligence where it will be most appreciated, satisfy you the most, and be put to the best ultimate use.
As you’ve noted, different smart people can have minds with drastically different strengths. Some people have spectacular memories. Some people are especially felicitous thinking with numbers, but not with words while with others it’s the opposite. Some people are capable of synthesizing disparate concepts in unique ways. Some are emotionally intelligent. Some people’s intelligence is all in their hands and they couldn’t explain any of it to you. Some artists can make things that some critics will never be able to, while those same critics may be able to analyze the structures and extrapolate the meanings of those artists’ works in ways those artists themselves could never dream to. Theoretical physicists, experimental physicists, and engineers there are three wholly distinguishable skills related to “being good at physics”. Some people are excellent empiricists but poor philosophers, and of course the reverse is true as well.
Probably more people could become more intellectually well-rounded than they presently are with proper education that (a) divided students according to differences in learning styles and taught accordingly, (b) was focused more on teaching concepts than rote memorization, and (c) involved more room for openended dialectical thinking. As a high school student I lost interest in math and science because I was repelled by the thoughtless memorization of mysterious and poorly contextualized formulas and facts that their study involved. I couldn’t fool myself with the pretense that I actually understood these subjects because I learned some standard manipulations of numbers and symbols or some free-floating scientific facts, the derivations or defenses or theoretical articulations of which I could scarcely fathom. Better to not fool myself that I understood what I had merely memorized, was my thinking. And so I immediately took to philosophy as a study where from the start we were engaged conceptually and theoretically and my struggles to understand felt like a feature, not a bug; i.e. the result of the subject’s being taught well, rather than badly. I greatly admire people ascend to true mathematical and scientific understanding but the grunt work of brute memorization that constituted the early levels of teaching of these subjects were roadblocks to my personal engagement.
Now, perhaps if I had had the right self-motivation or the wherewithal to seek the unusual tutor who would speak to my interests and find the keys to unlock my potential to think in mathematical or scientific terms sooner, I could have wound up going down such a path. Certainly my pursuit of a number of philosophical questions eventually led me to discover the excitements of a number of scientific questions and findings as I now had motivations that they could satisfy and in-roads to appreciate their theoretical beauty that I had lacked before. Now I delight whenever I can find an explanation of math or science that is pitched to my learning style and actively seek out tutors and books who can answer the questions have about math or science.
Now, as far as neuroscience’s recent findings go, I think we now know that the brain adapts significantly with practice in different ways of thinking. The more practice you have with making certain kinds of connections the more you will be able to make them. (And, presumably, the less practice you get, the less you will develop or retain the necessary structures for them.) You probably have the potential to develop your desired intellectual skills that aren’t yet natural to you, but right now you don’t know if you can develop them in the manner required by the academic system you’re working within at the present moment.
So, with all of this in mind, here’s what I would say to do and keep in mind.
1. By all means, see this semester through. You have very little to lose. It’s only five more months of your life. You are still very young, younger than you probably realize or feel, and in all likelihood you can afford to lose five months even if it’s on an unsuccessful endeavor. Seeing it through means knowing for yourself that you at least gave this your best shot and experienced it through to its resolution. If you decide you have to move on, that kind of closure would probably be a better thing.
2. A few years ago one of my favorite students from my philosophy classes, a young woman who could always be counted on to see the philosophical issues clearly and offer creative insights no one had taught her, came to me miserable because she was having a similar sort of problem to the one you’re having. She wanted to go to nursing school. She had to take biology and chemistry courses and she was struggling in them because she couldn’t memorize what seemed like meaningless strings of unrelated facts. I encouraged her to be proactive about her education by researching the medical relevance of the facts she was learning so that she could have a context for them that would spark her interests and motivate her mind to want to understand them. She was passionate about helping people medically as a nurse. If learning these facts could emotionally be related to that goal, then they could have salience for her. If she had a context for understanding why these facts mattered, she could apply her naturally philosophical mind to understanding them in that theoretical context. (I don’t know if this advice is directly the reason, but despite her deep struggles at the time, she is now in a very good nursing school.)
Ultimately, medicine is not merely a bunch of facts, it is an applied field. Every one of those facts matters. You need to start imagining for yourself the circumstances in which they will matter and that will not only give you the theoretical understanding of how those facts actually connect to each other, it will mean that you will be able to reason as a doctor with understanding, should you ever become one. If your professors won’t present the material in this way, you can spend your extra effort research time productively seeking out the bigger pictures through supplemental research that might replace some memorization time and stress with a more satisfying kind of intellectual engagement that makes bare memorization less necessary. One way to approach this is to read up on some of the history of scientific discoveries in order to understand what sorts of problems the scientists were trying to solve and how their theoretical approaches solved them. Also looking at current controversies will help with this since discussions of them will often give conceptual context. And reading popular science books will be good since popularizers use lots of narrative and analogy and focus more on the basic concepts than the technical details. They can be a good supplement to give you the bigger picture.
3. If you still do not succeed, then it’s time to think about what comes next. It’s not time to lose your confidence. You have made it as far as you have because you have a good deal of both innate and hard earned ability. If you don’t succeed here, you need to figure out whether there is another way to make up the work—this time systematically paying attention to how to correct for the pedagogical methods that don’t work for you—and still get into and thrive in medical school. Or you need to reassess your career plans. But your confidence shouldn’t be the issue. If it turns out that there is no other route to medical school or that the kind of learning that medical school requires is simply not the kind that your particular intelligence is best for, you need to focus instead on figuring out what kinds of careers specifically require the kinds of thinking you happen to incline towards, be good at, and enjoy, as well as which kinds of careers will have an education process that will engage you, make you happy, and allow you to be successful. How to figure out the best career deserves its own entire column, so I will save that for another time. The key that I would stress for now is that you should mold your career choice around your actual abilities. What abilities do you find joy in so much that you want to exercise, cultivate, and express them on a daily basis? What sort of a work environment excites you? What sorts of pleasures can you not live without in your daily work experience (and which kinds can you sacrifice)? What sorts of challenges or frustrations can you live with and what sorts should be deal-breakers? What sort of meaningful impact do you want your work to have? There is an extraordinary number of distinct careers out there. Whatever your talents are there are probably plenty of careers that can both use them and fulfill you. That should be your focus if it turns out that medicine is an ill-fit for your talents. The question you should entertain is never whether you’re smart or capable. You are. The vital question that deserves all your energies is what do you have the potential to be particularly smart and capable for, that will also bring you joy.
4. Take heart with the cold consolation that many other women and minorities suffer the same threats to have their confidence whittled down by endless doubters. You are not alone and it’s not your fault. Implicit bias is a real thing. And if relatively privileged white males can regularly be found suffering from impostor syndrome (and we certainly can), it can only be expected to be worse for people who have to face headwinds of prejudice. Becoming a doctor is not the only way to prove the naysayers wrong. And performing well on a handful of tests is not the ultimate test either. Nearly every successful person has numerous failures in their life. An incredible amount of the time the difference between success and failure comes down not to talent but to diligence. You must be diligent in seeking opportunities, in taking opportunities, and in following through on them for as long as you’re responsible for them and for as long as you’re growing from taking them.
5. Go back to prioritizing your social life, that probably worked before for a reason. Most people seem to thrive better when they focus for concentrated and efficient work time and then disengage completely from their work and allow themselves genuine relaxation, fun, and interpersonal connection. If you can regiment yourself into a strict schedule of long blocks of study time, punctuated with necessary breaks, and then significantly enjoyable time with friends or passions that have nothing to do with school, you will probably do better than if you try to work 24/7. The round the clock approach will usually involve a lot of fatigue, inefficiency, and proneness towards depression. It’s simply healthier to be disciplined such that when it’s time to work you really work and when it’s time to get away from your work you really get away from it and refresh yourself for it by temporarily absorbing yourself in something else.
6. Find the balance between the determination that you need in order to succeed, on the one hand, and the ability to envision failure without panicking, on the other. You can’t be halfhearted in your efforts. You need commitment and discipline to pull this off. But, at the same time, you need to cope with the doubts about your ability to succeed in a constructive way. And that means thinking through worst-case scenarios realistically. If you avoid thinking about the worst-case scenario then you will probably dread it more. If you actually think about it, you will probably find it reassuring to realize there are other opportunities that will remain even if this one dries up. You can even run by yourself hyperbolically terrible worst outcomes and make yourself laugh at their absurdity. Only then will you realize emotionally that you will not die from not getting into medical school. You will not be sent to prison for not becoming a doctor. There may even be some upsides–like you might wind up with a career path that also affords you a social life before your thirties! Allowing yourself to think about what the possibility of failure at this, allows you the freedom to start thinking about what other things you might want to be successful at. Right now you sound like you’ve wrapped your identity so much in the goal of being a doctor that no other futures have a chance of appealing to you. But even if you become a doctor you will be more than just that. You have potential that can, in principle, go in a number of directions and lead to a wide array of satisfying lives you’ve scarcely allowed yourself to conceive. You have to refuse your anxieties from convincing you that if you don’t succeed this semester everything you have worked for will be for naught and your life will come to ruin. In truth, you will still have everything you have already learned and all the abilities you have cultivated, and whatever honors, credentials, and experiences you have accumulated, all at your disposal. And you also have your youth. If in May your path to becoming a doctor prematurely ends, the smartest thing you can do will be to (a) digest the experience and come to some sense of closure with it and (b) focus your energies on the numerous other paths that open back up for to begin pursuing this summer or next fall. This semester, as you buckle down and try to see your current plan through, when your doubts come in you should use them as an occasion to dream instead of to cower. Use them as opportunities to think through prospects for life that you like but have ruled out as incompatible with medicine. You don’t have to know right now what you would do if the medicine plan fails, so don’t worry about not knowing what you’ll do. For this semester you’ll be sticking to the current plan. That means you have the room to do some self-assessment and to think through alternative scenarios without the pressure to have to choose one. Chew on them. Sleep on them. Give your imagination some room to play. If you start that process now, then even if you do succeed and go on to do medicine, you will still have gained greater self-awareness, better coping skills, and a larger horizon in your mind. And if you do wind up changing course next summer, you will come to a sense of closure faster and increase your likelihood of rebounding quickly. Failure’s not your enemy, despair is. You can overcome failures quickly if you are mentally flexible and proactive. But if you allow yourself to sink into depression and self-doubt, that’s a sink hole that could cost you years. Or, in the worst cases, decades or your life. Thinking realistically in advance about the possibility of failure is your best avenue to developing new hopes so that if you ever fail, you won’t despair.
7. If indeed any mental health issues are part of your problem, don’t hesitate to get to psychological counseling.
Relatedly, I recommend you supplement this post with my articles How To Live Happily: Have No Expectations, Philosophical Advice for a Procrastinating Graduate Student, and On The End of My Adjunct Teaching Career (in which you can see how I dealt with a loss of my own in a way that brought me very fast closure and a quick transition into a life that’s turned out even better than I could have imagined, two years later.)

Your Thoughts?

This was an installment in my Philosophical Advice column. To catch up or keep up with all installments in the “Philosophical Advice” Series keep tabs on this page. I am an American Philosophical Practitioners Association certified philosophical practitioner and I have a PhD in Philosophy from Fordham University. If you have a problem you think I can help with write to me at camelswithhammers at gmail dot com with the subject line “Philosophical Advice” and if I feel comfortable advising you, and can get to it, I will answer it here on the blog. All identities of those writing in for advice are kept strictly confidential. I use pseudonyms for all the letter writers when writing about them on the blog.

If you are interested in one-on-one advice sessions write me with the subject heading “Philosophical Practice”. All sessions are confidential. And it does not matter where you are in the world; philosophical practitioners are not bound by state certification requirements and restrictions, so you and I can meet online.

As a philosophical practitioner I help people reason through their beliefs, values, priorities, identities, emotions, ethical dilemmas, life decisions, existential quandaries, religious or post-religious struggles, love relationships, interpersonal conflicts, search for meaning and purpose, or struggles in any other areas of life that some conceptual clarification, logical consistency, theoretical sensitivity, and emotional intelligence can be helpful. I do not treat mental illness. I simply help people reason more clearly, consistently, ethically, and proactively about their lives.


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