If at first you don't succeed, try, try again!

Like the Little Engine that Could that said "I think I can, I think I can", the adage "if at first you don't succeed, try, try again" emphasizes the importance of stick-to-it-iveness. Both of these sayings highlight the qualities of courage & "grit" as critical ingredients to success. Courage and "grit" can take you a long way!

In 2006, as a founding faculty member at ATSU-SOMA, I was fortunate to have been one of a handful of faculty and administrators that worked collaboratively to launch a medical school from the ground up. We were tasked with creating curricula and assessments, planning for medical student academic success, and providing student support with a unique model that sent medical students out into community health centers after only one year together in Arizona (the traditional model has 2 years at a medical school site followed by 2 years rotating in clinical settings). We sometimes questioned the viability of the concept at the time but set forth to carve out a path to success. In spite of the early uncertainty (and sometimes skepticism) by faculty, staff, and administration, we moved ahead with stepwise planning and implementation to ultimately successfully graduate over a thousand medical students.

Looking back to those early days, I realize that students arriving at our new medical school with a unique curriculum and structure were the ones who were facing the greatest uncertainty out of us all. They had taken a leap of faith on a brand new school, one that had been created in alignment and collaboration with the National Association of Community Health Centers (NACHC) to help better serve the health care needs of the nation through a focus on providing primary care to the underserved. I marvel now at how these students made the decision to take a chance on a new school, and more importantly, how they were able to succeed! Because they did. Despite us. Despite the fact that new schools morph and take time to evolve. Despite the fact that they had started at the very beginning when the road ahead was still unpaved.

This led me to the question of, "what were the characteristics that defined those that succeeded"? If we could unlock the secret to success, everyone would succeed in all that they set out to do. What are the qualities one needs? Is it courage? Is it timing? Is it preparedness? It is intelligence? Is it innate talent? Is it simply good fortune or luck? Is it hard work? Is it courage to continue or carve out a new path in the face of uncertainty? Is it grit? Or is it a combination of all of the above? All in all, I believe that there were many factors that led to the ultimate success of this first class of medical students. It could have been any one of the many qualities mentioned above. However, the two that stand out to me by far were their courage and, for lack of a better descriptor, their "grit".

In order to succeed, I believe the first step for these students was having the courage to try. Without taking a chance and having the courage to step into the unknown, the opportunity for success would not have existed. It takes courage to take the first step and, perhaps more importantly, courage to keep going in the face of obstacles or adversity. For premedical and medical trainees, it takes courage to plan for a career that is based upon delayed gratification and sacrifice. It takes courage to know that you will be making decisions that can make the difference in a patient's quality of life, or in some cases, be the difference between life and death.

Next, once they had taken the leap and had the courage to venture forth, it was important to keep going! As I read Angela Duckworth's "Grit: The Power of Passion and Perseverance", I reflected upon the determination of how one's level of grit can help indicate how likely one can be to succeed. So, the question is, what is grit? Merriam-Webster begins by defining grit as "sand, gravel" and continues with a description of the abrasive qualities of these substances. Next in the definition of grit is "firmness of mind or spirit: unyielding courage in the face of hardship or danger". Interestingly, the definition itself incorporates courage! Duckworth's definition delves deeper and, in simplified form, focuses on the concepts of passion and perseverance. I believe Angela Duckworth's take upon "grit" is insightful and better explained in her book and/or TED talk. Of note, there have been challenges to her analysis of grit, though the underlying idea of the importance of perseverance is undeniable.

Was the first class of students we had unique in their experience? Perhaps in some ways, yet my disclaimer is that they are not necessarily unique from other medical or premedical students at other schools or in other situations. Our students had to find their way (albeit with help) as pioneers. Similarly, for premedical and medical students, despite where they are and what resources they have at their fingertips, the process of first gaining admission to medical school and then pursuing medical training definitely require both courage and "grit" as they venture into new and often unfamiliar territory.

My reason for exploring this topic now is that I have recently thought about the roles of courage and "grit" in my own personal journey. As I have ventured from the “comfort” of a long-term career as a physician in undergraduate medical education to launching a career of my own, I look back to my first class of students as inspiration for grit in the face of new challenges. It can be scary to traipse into the unknown. It can be unsettling to not know what lies ahead and where your journey will lead you. However, I can say from my own experience that, though it can be unnerving to head into change, ultimately it can be very liberating. Joy can be unearthed through new experiences and developing confidence in new skills and abilities. Not only does having the courage to take a chance free you from the fear of doing so, but it can strengthen and provide you with the opportunity to experience new challenges and successes in life. As such, thank you to the students who have inspired me to step out of my own comfort zone. I am enjoying the journey and looking forward to all that lies ahead! And if I can be of any assistance to premedical or medical students in your own journeys, I would be happy to help. Please feel free to reach out to me at rupalvoramd@gmail.com or call me at 602-295-0298.

Wishing you joy and success in all of your endeavors,

With courage and grit,

Sincerely,

Dr. Vora