My first serious rejection in life came in the form of a letter -- a rejection letter from medical school. All 10 I'd applied to in fact. I wasn't expecting to be shut out from my chosen profession. So, I regrouped, and I was accepted into medical school the second time around. I guess you could say I showed resilience 40 years ago, long before the term was cemented into the medical lexicon.
Resilience in my case was measured not by how I fared on my first try, but how I recovered from the setback and grew stronger in the process. I learned that determination and resilience go hand-in-hand. Whereas fortitude may be considered the backbone of resilience, rejection fuels our will and determination to succeed.
I have about my resolve to get into medical school. What's more pertinent is the way I have dealt with setbacks once I entered practice -- for example, a patient's relapse or untoward reaction to medication. I tended to personalize patients' misfortunes and . I came to realize that doubting my own competencies was a form of self-rejection.
How many times have we heard our mentors tell us, "Don't be hard on yourself?" We nod in agreement, but self-awareness doesn't necessarily overcome personal insecurities. A 2016 article concluded that a quarter of male medical students and nearly half of female students think of themselves as .
When the unexpected happens -- when a patient takes a turn for the worse -- it can feel overwhelming. I suggest we take a deep breath and focus on , a phrase coined by a physician living with Parkinson's disease. He said, "We have this saying at our house: 'one brick at a time.' Keep at it every day, even if it's just one small thing a day, just one brick a day, and eventually it will turn into a path."
Resilience is sometimes simply a matter of continuing to show up and not give up. If it's correct that 80% of life is showing up, well, I showed up. And there is a corollary that is equally true -- "Actually, I've found 90 percent of success isn't showing up, it's shutting up," which captioned a cartoon in the Wall Street Journal on June 6, 2013.
Different types of rejection test our resilience in different ways. After medical school, the most common form of rejection is failure to match into a residency training program. This crushing blow has derailed the careers of many physicians, sometimes permanently. Approximately 10% of fourth-year medical students from U.S.-based MD and DO schools fail to match -- and it requires a different approach to applying and interviewing. Successful reapplicants find resilience in their inner strength and courage to overcome adversity. They are able to unleash untapped potential when they need it most. Armed with resilience -- and a support system -- it is possible to overcome virtually any career impasse.
Medical students who have matched on their first attempt have also been labeled "resilient," but for totally different reasons than their unmatched counterparts. Medical school graduates in 2021 were deeply impacted by the coronavirus pandemic, not only in their experiences caring for patients, but also by changes in the residency application process, which included virtual interviews, cancellation of away rotations, and the rescheduling of board exams. Melanie S. Sulistio, MD, associate dean for student affairs at the University of Texas Southwestern Medical School, , "Not surprisingly, because of their unique experiences and perspective, these students are incredibly resilient, graceful under pressure, and have risen far beyond the call to serve others."
Medical student and resident resilience is a trending topic among medical schools as evidenced by the ongoing research and program development. But resilience is also important after residency, as our careers progress. I have had to summon resilience to cope with many types of rejection -- , government funding sources (for research), and even medical journal editors. One journal, in particular, has rejected my manuscripts a half-dozen times, always for the same reason: "Criteria for determining acceptance include priority, originality, quality, and appeal for our general medical audience. Unfortunately, your manuscript was judged by the editors not to have met the criteria necessary for publication." Undaunted, I found other homes for my manuscripts.
Recently, I tried my hand at writing poetry. Inspired in part by my adult son, a published poet and university instructor in creative writing, my submission was met with a quick and resounding rejection: "Knowing the frustration of many writers and poets, we strive to give a reply sooner than later. Unfortunately, given the volume of submissions we receive, even strong work such as yours has to be declined." If my poem is truly "strong work," why not try publishing it elsewhere? Eventually, I succeeded.
Resilience has many definitions and meanings. It commonly refers to the capacity to recover from or adjust easily to hardship or change. Resilience is the one trait that has helped me recover from setbacks marked by rejection. Whatever ordeals our professional lives may impose, it cannot match our innate ability to cope with adversity. And speaking for a cohort of physicians who have had the privilege of treating the full spectrum of humanity and marveled at the resilience of our patients and their families, perspective should probably be added to the list of coping skills we need to be resilient for the long haul.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, a 2021-2022 Doximity Luminary Fellow, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.