“Where do you see yourself in ten years?” “Do you know what specialty you want to pursue?” “How do you see yourself using your M.D. in the future?”
We all faced questions like this throughout the process of interviewing for medical school. In fact, these were probably some of the most common questions, and rightfully so — where you see yourself going, how your day-to-day career will look, and what kind of doctor you aspire to become all shape your desire to enter medicine. These questions were asked to ensure that we have a vision of how we hope to impact patient care before we embark on the four-year journey that is medical school, and ultimately, the decades-long journey that is a profession in medicine. These questions compel us to “differentiate” ourselves, both from other candidates and in our own personal career paths.
During interviews, I found these future-oriented questions energizing. It was exciting to imagine what life might look like as a practicing physician — a blend of seeing patients and conducting research, working on questions related to health systems financing and policy-making, accompanying families navigating complex health challenges, and collaborating with colleagues to advance the health care system on behalf of both patients and clinicians. Talking with interviewers about these topics was inspiring, and these conversations invariably left me with a clearer sense of where I thought I saw myself going.
However, upon arriving at medical school, these same questions that we once found exciting and energizing may begin to feel intimidating. “Where do you see yourself in ten years?” “Do you know what specialty you want to pursue?” “How do you see yourself using your M.D. in the future?” When our visions instantly change from imaginable to feasible, from describable to realizable, the onus suddenly shifts onto us to transform them into reality.
It is a simultaneous blend of inspiring and daunting to hear about classmates’ dreams as well. While it’s helpful to know that we are in this discernment process together, the uniqueness of our individual goals can sometimes cause us to question their validity or practicality. Is it really possible to practice medicine and build a profession in the niche we envisioned just a year or two ago in our interviews? What decisions will it take to make this vision come to fruition?
The process of decision-making and differentiation during medical school can feel paralyzing. Choices about specialties, research, and dual degrees feel like decisions that will affect the rest of our careers and our lives. It may seem that we have to close certain doors in order to follow our desired path. In a sense, this is true. We cannot do everything — a jack of all trades is a master of none.
An analogy to this process of discernment might be found in the determination of cell fate (yes, I’m bringing up CTB). “Terminal differentiation” is the process by which cells change their characteristics over time as they narrow in function from an undifferentiated state to their ultimate specialization. The process of neuron differentiation paints a beautiful picture of developmental trajectories. Early in development, brains undergo an explosive proliferation of neurons, forming billions of new connections as they are exposed to the environment. This proliferation is followed by a strikingly ingenious phase of “pruning,” whereby the nervous system purposefully removes connections that go unused. These two phases are traditionally discussed in the development and differentiation of the human nervous system.
However, what often goes unmentioned is “dedifferentiation.” De-differentiation is the process by which cells or tissues that have already specialized in function regress in their development — they un-specialize. Certain neurons may originally differentiate to perform one function, grow reversely to a less specialized state in response to a change in the environment, and subsequently re-differentiate to perform a new function. This finding is observed in many physiological processes, and its discovery marked a watershed moment in cell biology. It represents the ability to re-attain a pluripotent state that was previously thought impossible–the significance of possibility.
Perhaps we can use the phenomenon of dedifferentiation to make our future-oriented decisions feel less intimidating. In this phase of our discernment in medicine — the phase of beginning — we can and should embrace dedifferentiation. While we may have entered medical school with specific interests and articulated goals, it is perfectly normal to begin by growing reversely. Deciding to attend a seminar that you might never have thought you would have enjoyed could be the stimulus that triggers your redifferentiation. Taking a free class with a friend could lead you to discover an entirely new specialty, area of research, or dual degree. The prospect of “remaining open” may seem daunting or even counter-productive, but dedifferentiation is advantageous for development. It allows us to be flexible and adapt in response to our environments, and it provides information on what we are not interested in as much as what we are. Allow your friends’ dreams to serve as your own growth factors. Think of this phase of discernment as a time of proliferating, pruning, and re-differentiating. Just as a neuron forms, breaks, and re-forms its synaptic connections, three steps forward may necessitate one step back to gain perspective, and that’s perfectly alright– in fact, it’s part of what it means to begin.
Aidan Crowley is an MS1 at the Perelman School of Medicine.
Image by Tracy Du, an MS2 at the Perelman School of Medicine.
