Clarity and Opacity

I have a habit of declaring that moments in life offer clarity and re-invigorate (and re-define) the purpose behind what I do. Take, for example, my relationships: a series of dates, phone calls, e-mails, and then finally "what are we?" discussions lead to relationship bliss - the moments culminate to define The Relationship as it is. Or in MSTP training: good exam scores, successful grant applications, exciting results in lab, engaging clinical experiences might lead one to say The Career is a purpose-driven existence as a physician scientist.

But what if all along - instead of clarifying or defining - the milestones and the progress actually mean more questions rather than answers? What if tension builds rather than resolves?

I find this happening to me quite regularly. On one hand, things have been going pretty well -- I made it through the first two years of medical school without any major problems, the boards (at least step 1) is done and I passed, research has started (I'm learning new techniques, trouble shooting, etc) and I am funded for grad school (very lucky to have gotten an NRSA)...and I've managed to do a little bit of work in the clinic. So all-in-all, this sounds like The Career scenario above. Except that I don't feel like anything is really clarified. Rather, I see my future as quite unknown. Industry, consulting, purely clinical, purely research, policy, NIH, ahhh! I really have no clue what I will end up settling on for a career.

I think part of this dilemma (and total lack of vision for the future) stems from the nature of the first two years of the MSTP. On one hand, we are consistently medical students for the first two years. On the other hand, our program directors (and our desire to enter the PhD phase of the program with some obvious direction) require that we start thinking about our research goals; i.e. with whom will we rotate, into which program will we enter, and so on...So it's hard to firmly decide. We straddle the fence.



And now in the PhD phase, while it is tempting to completely immerse myself in research, I find myself inexorably drawn to the clinic for work every other week. Although it's for just one morning or afternoon, the experience re-affirms for me the uniqueness of my training plan. To not do this, in my mind, would be heresy; let's face it, we're doing these programs because we believe in the (tantalizing) possibility of translational research. How can we firmly believe in that if we're unable to give up two mornings or two afternoons each month to brush up on our clinical skills?



Indeed I have found my clinical experiences - interspersed within the beginnings of my research training - to be engaging and vital to my perspective on being a physician-scientist. But just as I have lacked clarity to this point, so do such experiences perpetuate the inevitability of opacity as status quo for the MSTP trainee.