How Should I Handle 'Gunners' on Clerkships?

Graham Walker, MD

Disclosures

September 01, 2011

Question:

How should I deal with competition between other medical students who are rotating through a clerkship together? What if I'm a gunner?

Response from Graham Walker, MD
Chief Resident, St. Luke's-Roosevelt Hospital Center, New York, New York

Medical students and their slightly more mature physician counterparts are typically competitive people. In order for us to jump through the hoops of organic chemistry, biology, physics, biochemistry, the MCAT reading comprehension section, and embryology, we need that inner drive to succeed. That drive is often helpful because it motivates us to learn, makes us work hard to achieve, and helps us find success.

And then there are gunners.

We can all spot them: They exist in every class, in every year, and in every medical school. They ruin the whole "helpful competition" vibe for everyone. It's much easier to avoid them during your preclinical years, but what to do when you're on a clerkship with them?

Nothing. Just be yourself, and do your best on the rotation.

Residents, fellows, and attending physicians have "gunner-dar." We can see gunners a mile away, and we don't like working with them because they create disruptions in the team and hurt morale and workflow.

It's easy to distinguish enthusiastic medical students from gunners. Here are some examples of their differences from my experience.

Enthusiastic students: Memorize their patients' lab results so that they can give fantastic presentations on morning rounds.
Gunners: Memorize other medical students' patients' lab results so that they can correct the students during their presentations.

Enthusiastic students: Are eager to see patients and ask for more responsibility when they're ready.
Gunners: Sign up to see more patients on their own when the attendings have tried to assign them patients throughout the shift.

Enthusiastic students: Read up on a topic and provide the team with an overview or handout so that they can learn more.
Gunners: Read up on a topic in order to correct other medical students (or even interns or residents) publicly about the topic.

How you behave during your clerkships boils down to simple common sense and common professionalism and courtesy. The residents and other team members are trying to learn more and become better physicians. It's great to be enthusiastic, energetic, and hardworking; in fact, these are the makings of a great medical student and future resident. However, it's also important not to overstep the bounds of your role or your knowledge base.

Do a great job with your patients and certainly make yourself shine. Just because you are doing well doesn't mean that your fellow medical students can't also do well. You're not being compared with the other medical students on the team: You're being compared with all the other medical students in the medical school. It's much more noticeable (and creates better evaluations for everyone) when the entire team does well than when one medical student does well and the other one struggles.

In addition, having another medical student on the rotation with you can be a boon to both of you. You can share pearls that you've learned throughout the month; you have a study buddy for those evil shelf exams; and you have someone with whom you can bounce off ideas and review presentations before you show them to the team. (Of importance, you have someone to commiserate with when you're stuck on a painful rotation or have a lazy resident leading the team.)

What if you think that you may be a gunner?

Of note, relax. Your classmates are not out to get you; they're out to succeed, just like you. The better that you and your colleague do on the rotation, the better that you both look. Also, there's no such thing as a subtle gunner. If you're overly intense or aggressive, everyone will be able to tell. Hospital life is stressful enough as it is. No one needs any additional stress that comes with managing medical student issues.

Lastly, gunners should remember these points:

  • It's likely that you and the nongunner are not going into the same field, so there is no reason to compete most of the time.

  • Even if you are going into the same field (eg, you're both on a subinternship), if a program likes both of you, they can take both of you. Just because you did a month-long rotation together does not make the 2 of you mutually exclusive.

  • Third, everyone remembers people's behavior in the wards. If you happen to match and stick around at your own medical center (or match somewhere else with other students from your school), no one will forget the time when they felt stupid because you corrected them on rounds one day.

The goal of medical school is not to prepare you to become an excellent physician; it is to prepare all of you to all become excellent physicians. Ignore the panicked "what if?" voices that might run through your head, and don't play the numbers game: I have to match here, and I'll only match here by proving that I'm better than everyone else!

Work hard by working together. Medicine is a team sport. Even if you're a solo practitioner in rural Kansas, you still need to be able to play well with others, including the consultants who you call, referrals that you make, and the staff with whom you work on a daily basis.

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