COMMENTARY

Why Do Today's Trainees Say No to Opportunities?

Don S. Dizon, MD

Disclosures

September 18, 2019

Back when I was a resident at Yale and a fellow at Memorial Sloan Kettering, I never said no. I realized early on that I wanted to stay in academic oncology, and to do this I said yes a lot, whether that was picking up a new lab experiment, writing a paper, giving a talk, or, as a young attending, squeezing in yet another new consult.

I saw these as opportunities: Who knew where they might lead? Saying no has never come easily to me, though with time I've learned to do it.

I've seen a generational shift take place in today's world of trainees, and I am not sure how I feel about it. I am often invited to write commentaries, for example, or to contribute an original article. Recently I was even asked to contribute to several textbooks. Where they were once my chance to grow in the field, I see who they could benefit now: those residents and fellows looking to try their hand in academic medicine, just as I had done so long ago.

Yet, more often than not when I offer trainees an opportunity, I get turned down.

"I'm too early in fellowship and am learning so much about all of oncology. I don't want to concentrate on this one thing."

"I'm so busy right now. I can't take on anything more."

"The topic just doesn't interest me. I hope you understand."

At first I thought, no big deal. But over the past few years, I've become aware that it's the new normal. Don't get me wrong: That my trainees feel confident and comfortable enough to say no to me makes me smile. It's a sign of independence and an effort to preserve work-life balance as they prioritize their responsibilities.

Did all of that 'yessing' make me a better doctor?

But on the other hand, it seems shortsighted. Residency and fellowship training don't necessarily imply a devotion to academics, but part of this training is critical thinking and the ability to synthesize data. For me, writing was one of the best ways to learn these skills. Whether it's a review article or a clinical trial, you are expected to review the literature and then summarize it—in and of itself an especially valuable task.

Even more, to be given opportunities to promote yourself and your institution, and then turn away from them at the earliest stage of your career seems, well, crazy.

As much as I am aware of this, I realize that it is not my problem to fix. Sure, I could twist someone's proverbial arm and "make" them write something with me, but that's not mentorship; and when I look back, no one ever forced me to do anything. My drive never came from a fear of disappointing any particular attending or any consequences that might befall me if I said no.

The drive came from me. I wanted to do these projects; I felt great satisfaction when I saw the proofs of an accepted paper with my name on it in my email inbox, and I was honored to give a talk, whether it be to a local group or required distant travel. I do what I do because I love it.

Did all of that "yessing" make me a better doctor? I don't know, but doing so solidified my choice to stay in academics. It helped me hone the skills I had as well as develop skills I lacked. I learned to respect deadlines and to multitask. More than that, I learned how to communicate with people and how to listen.

All of these skills are important—not just in medicine, but in life. I realize that trainees have their own passions and priorities, and maybe seeing their name on a paper isn't as important as getting home at a decent hour, especially after a long day and night on the wards.

But at the end of the day, I hope they learn to love medicine as much as I do: the art and the science, the interplay between physiology and psychology, the recognition of what we know and the realization of how much we do not. And I hope that instead of saying no, they discover their own passions, realize that they too can make a contribution, and ultimately learn to say yes.

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